Liam Fox – 2003 Speech at the Launch of Conservative Party Consultation Document on Health

The speech made by Liam Fox, the then Shadow Secretary of State for Health, on 5 June 2003.

Unless there is fundamental and radical reform, the NHS will never produce the quality of care we have a right to expect. And the people who would suffer most as a result would be the very people who rely most on the NHS.

Labour’s internal divisions mean it is unable to deliver the reform that many
recognise to be necessary. Only a Conservative Government will be able to deliver this.

Our experiences during our extensive travels convinced us that we must undertake far-reaching reform on three broad fronts:

– taking politicians out of running the NHS;
– giving real freedom to health professionals; and
– ensuring patients have real choice in health.

We believe that the NHS is there to serve patients not vice versa.

Freeing health professionals from the burden of red tape and the paperwork which targets bring will enable them to spend more time looking after their patients.

This is vital, since ultimately greater professional satisfaction is the only route to more health care professionals, something which Labour has failed to understand.

Our principle is that we want to see total spending on healthcare increase, but we will want to see the proportion of that spending that comes from other sources increase at a faster rate than that coming from the State. This will bring the UK more into line with the pattern of spending found in most of the European countries we have visited.

We believe that choice – a Conservative word – must be available to all patients who will receive their health care through the NHS.

But this alone is not enough. The standard of healthcare currently available to the British people is far below that which they have every right to expect in the world’s fourth largest economy.

Over recent years, whereas there has been minimal growth in PMI, the number of people opting for self-pay (frequently the elderly, reflecting the high cost to them of PMI and their desperation to avoid excessive waiting times late in life) has increased by an average of over 20 per cent a year.

In order to stimulate the creation of the new, non-NHS capacity referred to above, we will send clear signals that we are fully committed over the long term to measures designed to stimulate and strengthen demand in the voluntary and private sectors.

The most effective way of doing this is to make it more attractive for individuals to supplement what is already being spent by the State through the NHS. This will therefore be on top of what they spend through their taxes, not, as Labour falsely claims, as an alternative.

There are three main candidates which might be thus incentivised:

• Personal PMI;
• PMI available through company schemes; and
• Patients who pay for a single procedure or item of care
(the ‘self pay’ sector).

We saw examples during our overseas visits of cash rebates, tax incentives and reductions of the price at source, with the State reimbursing providers.

Attention needs to be given to companies who provide all their employees with a health insurance scheme and to those who negotiate reduced rates on their employees’ behalf with private insurers.

This will include the large number of Trades Union members who benefit from these types of scheme.

The self-pay market accounted for some 300,000 procedures last year (the age profile for which tends to be higher than that for personal PMI), a trebling since Labour came to power in 1997. If these patients did not opt to pay directly for defined elements of their care, in addition to what they have already contributed to the NHS through their taxes and National Insurance, they would be added to NHS waiting lists. It is doubtful whether the NHS would be able to cope with that extra demand.

Under our proposals, patients will be able to move around the NHS, with the finance for their treatment automatically following them. This will mean that for the first time there will be access to a truly national health service. Patients will be given a greater say over where and when they are treated, and by whom.

GPs could act as independent professional advocates for patients, advising them on factors such as comparative waiting times, outcomes and locations. This informed partnership between the patient and the GP would refute the argument advanced by Labour that patients would be unable to make sensible decisions about what form their treatment should take – a view which is both patronising and outdated.

There is no acceptance in Labour’s centralised monopoly model that patients have any ownership, in part or full, of the funds they have contributed through their taxes to the NHS.

We believe that the concepts of social solidarity – we all accept the need to cross-subsidise others in our society – and individual entitlement to contributions already paid are not mutually exclusive.

We believe it is simply unacceptable for choice to be available to a small proportion of patients. We want it to become the norm that patients are free to get treatment beyond the NHS whatever their income. We will therefore extend the Patient’s Passport to services beyond the NHS – that is to the voluntary, the not-for-profit and the private sectors – as soon as capacity allows.

This will yield two important benefits:

• It will become a realistic option for a much larger proportion of the population to have access to a very much wider range of healthcare providers than is now the case.

• Those who choose to have their health care provided within NHS hospitals will reap the benefit of shorter queues if more patients choose to have care elsewhere. Patients will, of course, be able to stay entirely in NHS hospitals if they choose: nobody will be compelled to go outside.

The value of the Patient’s Passport beyond the NHS – i.e. whether patients take some or all of the standard tariff funding that patients can take to voluntary or private hospitals – will need to take account of several factors: the total cost to the public purse, the level of available capacity from other providers, the predicted effect on NHS demand, the effect on the current private insurance market and the need to promote greater diversity in provision.

During the 1980s, the Conservative Government brought choice in home ownership to millions of people who had been denied it by socialist dogma.

This laid the basis for a home-owning democracy in which all social groups were able to take part.

The next Conservative Government will set patients free from the restrictions they face in the centralised Labour model of the NHS, so that all patients can benefit from the type of high quality and accessible care which is taken for granted by so many of our neighbours.