Tim Yeo – 2004 Speech on Patient Choice

Below is the text of the speech by Tim Yeo made on 10th May 2004.

I am delighted to have this chance to attend your Congress. Not just to speaking this session but also to meet many of you as I have been doing since I arrived in Harrogate. I have already had valuable discussions with Beverly Malone and I look forward to continuing those in coming weeks and months.

Later this week we will recognise Nurses day. Today I would like to pay tribute to the tremendous work you carry out in the NHS, 24 hours a day, 365 days a year and to express my appreciation of the huge contribution which nurses and all health professionals working in the NHS make to our society.

I am well aware that over the past few years your job has got harder. Despite the increase in staff numbers which ministers so much like to trumpet, there are still too few nurses working in our hospitals.

Equally important there are too few nurses working in our communities.

As nurses you are caring for patients who have more complex illnesses than ever before.

Alongside this you are expected to treat patients faster. There are fewer beds in the NHS today than there were a decade ago. Demand for these is high and great pressure is put on managers to move patients on so others can take their place.

And as things stand, that pressure is going to increase.

As a nation we are living longer. The number of pensioners has already overtaken the number of children in this country for the first time. It will be a major challenge to provide the next generation of elderly people with the services they require. All the more so as a result of 70,000 care home places lost since 1996.

I am here today to give you a better understanding of what you can expect from the Conservatives.

It’s just over six months since Michael Howard phoned me and asked me to take on my present role in the Shadow Cabinet. I was thrilled to be offered the chance to return to the health field, in which I have had a long standing interest.

My last full time job before entering politics was as Chief Executive of The Spastics Society, now called Scope. The Society’s activities included the provision of long term care for adults with disabilities, short term respite care for both adults and children, and the sponsorship of medical research.

I went on to start the successful campaign to keep open the Tadworth Court Children’s Hospital – the country branch of Great Ormond Street Hospital for sick children – and became the first Chairman of the Trust set up to manage the hospital.

After entering Parliament I became a member of the Health Select Committee and later one of my ministerial posts was at the Department of Health where I was responsible under Virginia Bottomley for social services, mental health and children.

Inevitably that experience has shaped my perspective on the challenges we face now to sustain a world class National Health service.

Let me make clear at the outset that the Conservative Party is totally and utterly committed to the founding principles of the National Health Service.

We will maintain a service that provides care which is free to patients at the point of use. Which is available to everyone on the basis of need , not of ability to pay.

That is Michael Howard’s view.

That is my view.

That will be the basis of our policy when we form a Government

Our aim is to improve and strengthen the NHS, not to destroy it as some of our opponents try to claim.

When we highlight some of the major problems, we are not talking the NHS down

We know full well that much of what goes on in the health service is excellent. Every day thousands of people are satisfied with the care and treatment they receive. Genuine progress is being made in many areas, not least in cancer, most of it the result of tremendous hard work and dedication on the part of those who work at every level in the Health Service.

But in our view these improvements are happening despite the system and not because of it.

And the plain truth is that things are not as good as they should be

If they were, why do over a quarter of a million NHS staff – 22% of the total- leave each year and have to be replaced at a annual cost of £1.5bn – before you take into account the cost of lost experience?

While I welcome recent announcements on reductions in waiting lists, I still ask myself – Why is it that we should have to put up with health rationing in this country when for example in France the concept of a waiting list does not exist?

And I share the public’s cynicism about statistics emerging from this Government . Average waiting times have not improved . We are all aware that data can be manipulated by delaying scans or access to consultants. More people are resorting to paying rather than waiting like the former fireman in Wiltshire who used his redundancy money for his wife to be treated privately when she was told she would have to wait 18 months for an hysterectomy.

Whether you believe the spin or not, there is growing consensus that one consequence of Government focus on waiting lists is that the needs of the 17 million people with long term medical conditions have been neglected. Similar concerns exist over mental health.

And the shocking report produced recently by the European Respiratory Society confirmed that Britain has one of the worst records on respiratory disease, with death rates twice the EU average.

Not only is Britain lagging behind other countries. In some areas of public health, things have clearly got worse since 1997.

Obesity rates in both adults and children are increasing. Rates of sexually transmitted infections are getting worse. Notifications of tuberculosis are up by over twenty per cent in the United Kingdom since 1999.

And I know that it’s as worrying for nurses as it is for patients that on average, 13 people a day die from MRSA, caught in hospital.

Figures published by the Health Protection Agency this Spring show that the number of people dying from the MRSA ‘hospital superbug’, has increased by 106 per cent since 1997 in England and Wales.

Most people in the country will agree with The Chief Medical Officer who described the figures as ‘shocking and unacceptable’ .John Reid’s answer is to introduce some more bureaucrats and give nurses badges saying ‘ Ask me if I have washed my hands’.

It’s time to get serious about the basics. I believe nurses in charge of wards should be given the authority to ensure that wards are clean, with the power to stop payments to cleaning companies if the job has not been done properly.

I’ve drawn attention to these shortcomings not because I believe that all the news about the NHS is bad, but because to hear some of the claims made by Ministers, you’d think everything was perfect.

Far from it. My diagnosis points to three failings.

Yes, welcome new investment is going in but too much money is being wasted on layers of administration that don’t add value to patients.

Secondly there has been too much interference from politicians in the running of the NHS. Too many initiatives driven by the needs of spin-doctors not patients. Too little trust in the competence and judgement of qualified professionals in the front line

And thirdly as a result of that political inteference, a culture has grown up which too often seems to treat patients as statistics and the people we rely on to deliver care as just cogs in a vast bureaucatic machine.

These are not failings of the professionals who work in the NHS but of the politicians who have got their priorities wrong.

Let me illustrate some of these concerns

I am concerned about waste because the more money that’s wasted, the less there is to recruit and retain permanent nurses and doctors. The less there is to support Agenda for Change.

That’s why I’m horrified by the increased cost of the NHS Administration and Estates Staff in England from approximately £3 billion to £5 billion since 1997. A jump of almost two billion pounds in five years – all spent on bureaucracy.

Over the last year the number of managers has increased at almost double the rate of nurses.

And Department of Health administration costs have increased by £40 million since 1998.

Then there’s the Modernisation Agency, introduced as a result of the NHS Plan, with a staff which grew to 760 in three years and consumed an annual budget of £230 million. It will soon cease to exist in its current form.

What have these millions of pounds spent on bureaucracy delivered in terms of improved patient care?

Last month a leaked ministerial document in the Sunday Times revealed that since 1997, Health productivity as measured by consultant episodes has actually fallen by 15%. Productivity may not be a useful measure for nursing, but the report, and the way the Government sought to conceal this information, suggests that something may be amiss.

How did ministers respond? By asking that the basis of calculation be changed to make them look better.

Which brings me on to my second concern , the level of political interference in the NHS .

We did a consultation exercise last year. From the hundreds of letters we received from health professionals , one consistent message came through loud and clear.

Leave us alone to do our job!

I agree.

It is time for politicians to stop trying to micromanage the NHS.

With over 400 targets in Labour’s NHS plan ,we are in danger of forgetting what the Health Service is for.

We know how this target culture takes up your time and the time of other professionals.

We know how it distorts clinical priorities and demotivates staff.

Last year, a House of Commons Committee heard evidence from Dr Richard Harrad of the Bristol Eye Hospital who explained that waiting time targets for new outpatient appointments at the Bristol Eye Hospital had been achieved at the expense of cancellation and delay of follow-up appointments. The result was that 25 patients went blind.

And the chilling words from Ian Bogle, outgoing Chairman of the BMA Council who said,

‘The one memory that will linger long …. is the creeping, morale-sapping erosion of doctors’ clinical autonomy brought about by micro-management from Whitehall which has turned the NHS I hold so dear into the most centralised public service in the free world.

He continued:‘We now have a healthcare system driven not by the needs of individual patients but by spreadsheets and tick boxes.

What a damning indictment of the environment you are being asked to work in !

Nothing is more important to the quality of patient experience than the role of nurses.

But as a result of added bureaucracy and continued staff shortages, nurses still experience difficulty in finding sufficient time to attend to the needs of patients.

Yes there are more nurses, but not as many as the Government would have us believe.

Within some categories there are in fact fewer numbers of staff now than in 1997. For example the number of health visitors has decreased since Labour came to power, as has the number of district nurses working for the NHS.

And the statistics, if not my eyes, tell me that nurses are getting older.

According to an RCN study , 100,000 nurses are due to retire in the next 5 years .Combine that trend with the current 15% fall out of trained and student nurses each year , and it is clear that the Government is running hard to stand still on nurses numbers.

It is typical of them to go for the quick fix. You know better than I how increasingly reliant we are on agency staff and on nurses from overseas, often from countries that cannot afford to lose them. These are unstable props on which to build for the future.

Meanwhile this country continues to export qualified health professionals. Last year, for example, the number of nurses leaving the UK to work in the USA doubled.

We need to show much greater urgency in addressing the reasons why nurses are leaving and why the Government has failed to persuade them to return to the NHS.

Yes, I recognise there are real issues around pay and access to affordable housing.

As with all professions, nurses need to feel that they have a career ladder to climb should they wish to do so. And this should not mean having to move away from patient care and into management. In this context I see Agenda for Change as a step in the right direction.

We need to look creatively at ways to incentivise experienced nurses to defer their retirement plans whether it be through more flexible hours or financial rewards, linked to length of service.

And we need to pay particular attention to how we encourage future generations into nursing. I particularly want to understand why so many students drop out of training. Is it because courses focus too much on the academic aspects of nursing rather than the practical elements? Or because nurses struggle to find convenient clinical placements to complete their training ? And when they do find such placements, are they being adequately supported and supervised? Or are the hours so inflexible that they can not accept them?

And last but by no means least , we must address the workplace issues that frustrate what I am sure remains the core instinct of every nurse – the desire to give the best possible care to people who can’t help themselves.

Too much form filling; too much inteference; confused layers of authority; insufficient resources to do the job.

These are some of the responses I have received, but it’s not for me to tell you – its for you to tell me.

So what difference would the Conservatives make? What can you expect from us?

First, we recognise that the National Health Service has been subjected to continuous reform over the last few years and the last thing it needs is further root and branch upheaval.

That is why our policies for the health service propose a change in approach rather than disruptive structural reform.

Politicians talk too much about structures and about money. These issues are important but we must not lose sight of what matters to patients. Everyone would rather be healthy than be ill so Government’s first aim should always be to improve our prevention strategies, something that Ministers lose sight of if they become bogged down in trying to micro manage the NHS.

And when people do become ill they want fast access to consistent , high quality care which treats them with dignity as individuals. This is what the people who pay for the NHS deserve .

Our plans for helping the NHS deliver that on a more consistent basis reflect tough lessons learnt in the past – both in Government and opposition .

They are built around three interdependent pillars.

Firstly, we are committed to invest the money that will give you the tools to do the job.

Secondly, we see our mission as taking the politics out of an NHS that has been a political football for too long.

We are determined to free qualified professionals from the bureaucracy that too often gets between you and the patient who needs your help.

Thirdly, we want to give those patients much greater say over where they are treated. With that power of choice we believe comes the power to get quicker treatment and to force improvement in the service they receive.

Let me give you a clearer idea of what that means.

Underlying our commitment to the NHS is the promise made by my colleague Oliver Letwin, Shadow Chancellor last February.

In the first two years of the next Parliament a newly elected Conservative Government will match Labour’s spending on the NHS.

This means that regardless of who wins the election, spending on the NHS will increase by broadly the same amount.

So the debate is not about ‘ How much money? ‘ but ‘ How will you spend it?’

And we are determined to spend it better , with much fewer layers of administration to divert money from the front line.

Our mission to give hospitals much greater freedom means that many more decisions about investment will be taken locally by people who are closer to patient needs. Labour talk about this but will not deliver. The instinct of Gordon Brown’s Treasury is to control everything from the centre and drive improvement through national targets. I believe very strongly that this is wrong. The system was too centralised when I was a Minister twelve years ago. It’s far more centralised today.

That has to change. It’s not the job of the Secretary of State to be Chief Executive of the NHS. It’s time instead that he and other politicians admitted the damage that results from incessant interference

So we will scrap targets and star ratings. Standards will continue to be monitored by CHAI within a framework set by Government but Hospitals will become accountable to patients not bureaucrats.

And the money will follow the patients. So that success will be rewarded and failure will not be tolerated for so long.

And because we are determined to give patients more choice, we need to invest in making more capacity available to them . Critically that means a quantum leap in the number of qualified permanent doctors and nurses. We do not underestimate the challenge but know that we can go much further than Labour in stripping away the red tape and bureaucratic interference that is so damaging to job satisfaction. Indeed I know from my seven years as Chairman of the Tadworth Children’s hospital that when nurses and other professionals are set free from artificial external controls,job satisfaction and staff morale increase dramatically. The whole of my experience – in business and politics- convinces me that the more you trust professionals to do their job the better they will do it.

That will be our way.

Both Conservatives and Labour talk about extending choice. The difference lies in scope and commitment.

Our programme of choice goes with the grain of Government initiatives to establish a national tariff and electronic patient records. But we intend to go further than them in extending choice. We have called our instrument of choice – the Patient’s Passport.

Any patient requiring elective treatment will be able to use the passport. We intend the passport to be just as relevant to those with chronic conditions as it is for those who require hospital treatment. Of course the choice of pathways for someone with a chronic condition will be more complicated to map, and in some cases the framework of standards is not yet clear. So this is why we have already started our discussions with the relevant organisations on how best to translate our policy into action for those with chronic conditions.

The passport will enable the patient, usually in consultation with a doctor or another professional, to decide where they go for treatment. That may still be their nearest hospital, but it could be another hospital where the waiting time is shorter, or which is more convenient for their family, or where clinical expertise is greater.

Choice will be informed with information on waiting times, treatments and outcomes available to them and their advisers.

But the choice will be theirs.

Our proposals represent a comprehensive of programme of patient choice. This means that, for the first time NHS patients can choose to be treated in an alternative setting to the NHS.

Should they decide to do so, our proposals will allow them to take a proportion of the NHS cost to assist them with the payment of their treatment elsewhere.

Not only does this give patients more control over where they are treated, but it will also help those who elect to stay within the NHS by giving them faster access to NHS treatment. It is not about taking resources from the NHS. It is about taking pressure off the NHS.

Labour can hardly criticise this aspect of our policy. After all they are now buying services from the private sector at an ever increasing rate

Our choice agenda will cut waiting times because patients will have the right to go where the waiting list is shortest.

Because the money goes with them , their right to choose will make providers of care more responsive to their needs.

It will stimulate new provision both inside the NHS and outside. As long as we maintain a service that provides care to an acceptable standard , which is free to patients at the point of use, then we have no political obsession with who owns that capacity.

But we are committed to help the NHS respond to this new environment.

Through a massive programme of investment to make sure the resources are there .

Through immediate withdrawal of politicians from day to day management of the NHS , giving qualified professionals the freedom to address patient needs.

It boils down to where trust is best placed.

After 7 years, it is clear that Labour places its trust in Whitehall.

Our vision, born of experience, is different.

Trust is best placed with patients and the people they trust. You.

Our vision is to give Britain a truly National Health system in which every patient has access to any doctor and any hospital , and where doctors and nurses choose to stay because they are respected and given the freedom to deliver a standard of care that they are proud of.