Liam Fox – 2000 Speech to Conservative Party Conference

Below is the text of the speech made by Liam Fox, the then Shadow Health Secretary, to the 2000 Conservative Party Conference on 3 October 2000.

At our conference this week voters don’t need us to remind them that health has actually got worse under Labour.

They don’t need us to remind them that their tax has gone up with nothing to show for it.

They don’t need me to remind them about the increased number of people waiting to get treated, the jobs for Labour cronies, the repeated announcements, the PR stunts, sound-bites, photo opportunities, re-launches, postcode rationing, trolley waits, cancelled operations and the elderly ‘not for resuscitation’.

And all at the hands of a Prime Minister and Secretary of State who represent the most smug, arrogant, complacent, out of touch, ‘blame someone else’ and downright incompetent administration the NHS has ever known.

No, they don’t need to be reminded – so I won’t.

But disillusionment with Labour is not enough. What people rightly want to know is what we would do differently. We are the Government in waiting. It is our duty to outline our approach.

Let’s begin by dispensing with Labour’s great lies in leaflets like these. We will match Labour’s spending plans for health pound for pound. We believe in a comprehensive National Health Service funded from taxation free at the point of use.

When Alan Milburn was still peddling CND propaganda in his socialist bookshop, I was one of those overworked junior doctors in the NHS.

I spent all my working life before politics as a doctor in the NHS so when Tony Blair says that we intend to cut doctors and nurses, he is not only lying but he knows he is lying.

Unlike Labour’s NHS, ours will be one with proper priorities, where the sickest patients are treated first.

Where the value of our care is measured by more than just the numbers treated.

Where doctors decide which patients are treated, and not bureaucrats and where politicians stop interfering.

Where new partnerships are formed inside the NHS and between the public and private sectors.

It doesn’t matter to us where a patient is treated but when a patient is treated and the quality of that treatment.

Patients have a right to expect us to arrange the best treatment we can . If we can use the private sector to speed up the treatment of NHS patients then we should do so.

We should not be treated by the State like some Dickensian paupers having our gruel dispensed and expected to say thank you because it’s all there is. We are citizens and taxpayers in the world’s fourth biggest economy at the beginning of the 21st century. We have a right to expect something better.

But rights also imply responsibilities. Patients who make emergency night calls for trivial complaints, who use ambulances as a taxi service, or who fail to turn up for their hospital appointments are denying others potentially life saving services. And it can not continue.

REMOVING POLITICAL INTERFERENCE

Sometimes when I look at the NHS, I think that only a fool would believe that you can run a service that employs almost a million people from behind a Minister’s desk in London.

It is crazy to believe that one person can tackle the different and detailed health needs of Penzance, Preston and Peckham with a single ‘one size fits all’ solution dreamed up in Whitehall.

And it is unacceptable that a party political Secretary of State can decide who sits on every health authority and pack it with his own supporters. We will bring this disreputable and shameful practice to an end.

Actually, by letting the experts run the NHS I intend to be the least over worked Health Secretary in history.

SETTING THE RIGHT PRIORITIES

Next, we must change the targets we use. For too long, under Conservative as well as Labour Governments, we have been obsessed with targets based on input or throughput. In other words, you are doing a better job if you spend more money irrespective of how you spend it or if you treat more patients, irrespective of whether or not they are the right patients. That is not a sensible approach.

We need to have targets which are based on the outcomes for patients.

That means we need to raise our cure rates and survival rates to match those in neighbouring countries. It is not acceptable that if we develop lung cancer or breast cancer or colonic cancer or heart disease that our chances of survival are sometimes only half of the Dutch or Germans or Americans.

But meaningful targets need investment and not just slogans. That is why, although we will match Labour’s spending plans for health we will spend that money very differently. Our plans mean that investment will be directed towards priority areas beginning with cardiac and cancer services as a first step in delivering our Patients Guarantee. And we will abolish Labour’s iniquitous waiting list initiative which so distorts clinical priorities.

Am I the only one who believes it is unethical and immoral to deny lifesaving treatments in order to speed up more minor ones?

Am I the only one who finds it repulsive that patients have their cancer or cardiac surgery cancelled while surgeons are forced to carry out more hernia surgery so that ministers can claim better figures?

Am I the only one who believes that the sickest patients should be treated first?

It is time we had a system based on sound values, not sound bites.

Yet there are those who urge us to reject this approach. They say “Don’t do it. You may speed up cancer care and improve cardiac care but there are more people with ingrowing toenails, varicose veins and sebaceous cysts and they all have votes.”

Has our society really become that shallow?

Do we really believe that people really think of no one but themselves ?

I don’t believe so. Too many of us here today will have had family, friends or neighbours who have died prematurely as a result of the failure to prioritise our health care.

I believe that in the British people there is a sense of fairness and decency which is offended by this Government’s approach. We Conservatives must be their voice.

Politics is not about following focus groups but informing and leading public opinion.

It is time we got back to doing what is right not just what is popular in the short term.

THE BEST USE OF OUR STAFF AND RESOURCES

Of course, the NHS cannot only be about life threatening conditions and, in time, we want to see all waiting times reduced. That is why, as a first step, we support the idea of “stand alone” surgical units for procedures such as cataract surgery or hip replacements. These units, dedicated to a single type of treatment, could work more efficiently (perhaps even round the clock) enabling us to end the scandal of operations being cancelled at the last minute.

Under Labour the NHS is increasingly being run British Leyland in the 1970s where you don’t want to be sick after five o’clock or at weekends and heaven help you if it is a public holiday.

Indeed there is a general need to use our staff more efficiently. As a GP, I spent a lot of time doing things for which I was over-trained. We don’t need someone with nine years training to take blood pressures or blood samples. Doctors and nurses need to be used at the ceiling of their abilities.

For example in my own area of general practice I want to see GPs develop specialist skills to complement their generalist role. When a parent takes their child to the doctor with a problem it would be nice to see someone who had experience in paediatrics or if a woman goes with post menopausal bleeding she should be able to see someone who has trained in gynaecology.

Many of our GPs already work as clinical assistants in hospital out- patients clinics. It makes sense to develop a new level of care in general practice, with semi specialist GPs so that patients can be seen more quickly and locally and hospital outpatient clinics are used for those who genuinely require a Consultant level service.

In the same way, I believe nursing has come of age. In breaking down the territorial barriers we will offer nurses a real opportunity to make full use of their skills.

These developments will have impacts on training.

We need to recruit nurses from a wide spectrum and training must be flexible enough to accommodate a whole range of skills from simple patient care to further academic development.

We must never forget that holding the hand of someone who is afraid can be just as important as operating complex equipment.

And it is time that we all got back to recognising something we seem to have forgotten – that nursing and medicine are not just jobs but a vocation, and should be valued as such.

EXPANDING THE PRIVATE SECTOR

Despite the lies being perpetrated by the Labour leadership, we have repeatedly made it clear that we will match Labour’s planned health spending. It will be welcome and it will allow a vital expansion of our health care. But it will not be enough in itself.

If we want to see total spending on health care brought up to European levels we will need to see the private sector increased as well as the NHS. That means making private health care more attractive.

To be blunt, the private sector also needs a shake-up. Too many products for individual private health care are too expensive, inflexible, with too many exemptions and covering you for everything except anything you have ever had.

This is especially difficult for the elderly made worse by the Government’s removal of their tax relief on private health. This is a government that seems to have entirely abandoned the elderly.

Labour have also hit company schemes too adding yet another burden to the NHS.

We must not back away from the challenge to make private health care more attractive in addition to the extra NHS spending.

A bigger cake benefits everyone if a real partnership is introduced. In order to encourage company schemes we will abolish disincentives in the taxation system where and when we can afford to do so.

This will ensure that additional provision is available to as wide a range of our fellow citizens as possible.

Choice in healthcare should not just be for the well-off.

By improving choice within the NHS and making access to the private sector cheaper and easier we can bring our spending on health up to the levels of other western countries and close the real health gap.

Labour will oppose us, just as they opposed Conservative trade union reforms which gave individuals more power and just as they opposed Margaret Thatcher’s council house sales which gave so many a share in prosperity.

Our instincts were right then and they are right now. Labour support the state. We support people. A better NHS and an expanded private sector working in a real partnership can benefit all our people.

MATRON’S VALUES

But health is not just about structures and money. It is also about values. I want to see a return to what I would call ‘Matron’s Values’.

It seems ludicrous to me that ward sisters are not in control of cleaning wards and feeding patients.

When the ward sister says jump the response should be “How high?”, and not “I need to call my supervisor.”

We need to give those who have the responsibility for patient care the authority as well.

One of my elderly neighbours has just come out of hospital. She was very unwell and unable to eat as well as being extremely deaf. For dinner she was given some rock-hard battered fish. There was a time when someone would have said make this lady some scrambled eggs which she can eat. But no, half an hour later the offending fish was simply whisked away untouched.

I’m sure you all know similar examples. It is not about major policy initiatives. It is about seeing patients as people not illnesses with a nametag. Sometimes in health it’s the little things that matter most.

And another thing. I cannot bear this habit of calling people, especially elderly people by their first name when they don’t want it.

My grandmother was never called Sarah in her life, not even by my grandfather. (I won’t say what he called her). She was always known as Mrs. Young. When she became confused she didn’t know who this Sarah was. And it’s not good enough.

We must understand that we are dealing with individuals who have their own identities, sensitivities and pride which should be respected. The Cabinet may call one another Tony and Jack and Mo. Our patients have earned greater respect. Dignity is their irreducible core.

TELLING THE TRUTH

We have a great challenge ahead in the debate on health – to tell the truth.

There is no endless flow of money. We cannot do everything we would like as quickly as we would like. Medical science is expanding faster than our ability to fund it. In the real world choices must be made, priorities must be set. There has always been rationing and there always will be.

We must have the courage to say what we know to be true.

And yes that means if doctors from overseas are not properly qualified and do not have adequate communication skills, then we will say so, irrespective of the knee jerk reaction of the PC brigade and their media allies.

You know promising things you cannot deliver in politics is cynical and creates resentment.

But promising things you know you cannot deliver to the sick and vulnerable is wicked and cruel. That is the charge at Labour’s door.

We must show that we are not just a party of pounds, shillings and pence. We must show what sort of Britain we want to live in and how we will achieve it.

Our way will be different.

Where health care is run for the patients not the politicians.

Where decisions are made by doctors and nurses not bureaucrats.

Where heart bypasses are not given the same priority as in-growing toenails.

Where vocation is once again valued.

Where we treat patients with dignity as individuals, where we tell the truth and do what we believe is right in tune with our beliefs, our experience and our values.

It is time to restore faith in health.

Let Labour play follow the focus group.

Let us say what must be said and do what must be done.

Let our party prepare again to lead our Nation.