ConservativeHome's ToryDiary

David Cameron launches campaign to save 1,600 GP surgeries

The 10p tax band and post office closures are the two trickiest issues for Labour on the doorsteps at the moment.  David Cameron aims to add a third today with a warning that 1,600 GP surgeries are under threat from Government plans to create a national network of "polyclinics".

The Government believes that the wider range of services that "polyclinics" will provide - including pharmacy and diagnostic services - as well as longer hours will compensate for any decline in the number of local surgeries.

Speaking to the King's Fund Mr Cameron will say: "Communities which have lost their post office, their local shops and their local police station, are now going to lose their doctor."  See Telegraph report.

Related link: Julia Manning's campaign to 'Give GPs a break'

3.15pm: John Crippen on CentreRight - Polyclinics - supermarket medicine for the poor

Vindication for David Cameron as Brown retreats on Embryology Bill

It was two weeks ago that David Cameron challenged Brown at PMQs to follow his lead and grant all MPs a free vote on the Embryology Bill.  Today, after a fortnight of internal pressure from Catholic MPs and from religious leaders, Brown has abandoned his three line whip.

Andrew Lansley, Shadow Health Secretary, isn't completely convinced however:

“It remains unclear whether Labour MPs will have to vote against their conscience during the passage of the Human Fertilisation and Embryology Bill. Over a year ago, we asked the Government to give MPs a free vote on embryology legislation.  Conservative MPs will be given a free vote but Gordon Brown is still dithering today.  In order for the Bill to command public confidence, MPs must be allowed to exercise their judgment. Why doesn’t Gordon Brown understand this? If he really believed that no-one should be forced to vote against their conscience, why did he impose a Whip on Labour Peers when the Bill was in the Lords?”

Conservative MP Nadine Dorries has begun a daily campaign on her blog to encourage pro-Embryology Bills in marginal seats to vote against the Bill, that its fiercest opponents have dubbed the 'Frankenstein Bill'.  In today's Times David Cameron warns against demonising the Bill:

"My own view, and I think [that of] many people in the Conservative Party, is we need to update the legislation. This sort of research is important. We all want to see diseases reduced and problems that children have, birth defects, dealt with.”

Lansley slips in latest shadow cabinet ratings

David Davis is back at the top of the shadow cabinet league table - overtaking William Hague.  The views of 1,529 members were collected before Thursday night's Question Time programme - during which David Davis made a humorous one line attack on Labour's approach to civil liberties.  From memory he said something like 'Labour do not seem to understand that Orwell's 1984 was a warning not a template'!

The big loser this month is Andrew Lansley.  Last month his net satisfaction rating was +49%.  This month, following his loose-tongued Times interview, the man already confirmed as the next Tory Health Secretary (electorate permitting) dropped to +26%.

Osborne also drops again a little.  David Willetts, however, continues to climb gradually upwards - recovering slowly but surely from grammarsgate.

1. David Davis +79% | +78% | +83% | +88% | +88% | +80% | +85%
2. William Hague +76% | +71% | +84% | +88% | +87% | +85% | +84%
3. George Osborne +24% | +7% | +79% | +85% | +81% | +76% | +70%
4. Chris Grayling +36% | +29% | +47% | +59% | +58% | +69% | +66%
5. Liam Fox +49% | +46% | +65% | +69% | +71% | +64% | +65%
6. Alan Duncan +40% | +28% | +47% | +51% | +55% | +55% | +57%
7. Michael Gove +40% | +30% | +53% | +61% | +58% | +52% | +50%
8. Lord Strathclyde +43% | +40% | +48% | +54% | +54% | +53% | +49%
9. Nick Herbert +19% | +19% | +38% | +41% | +44% | +40% | +44%
10. Philip Hammond +17% | +14% | +36% | +42% | +42% | +38% | +40%
11. Eric Pickles +31% | +27% | +38% | +41% | +45% | +39% | +39%
12. Pauline Neville-Jones +15% | +11% | +25% | +38% | +38% | +30% | +35%
13. Caroline Spelman +34% | +27% | +24% | +30% | +32% | +32% | +31%
14. Jeremy Hunt +10% | +7% | +19% | +20% | +21% | +24% | +26%
15. Andrew Lansley +20% | +24% | +43% | +45% | +46% | +49% | +26%
16. Peter Ainsworth +8% | +3% | +16% | +22% | +23% | +18% | +22%
17. Oliver Letwin -6% | -14% | +17% | +23% | +21% | +20% | +21%
18. Andrew Mitchell +10% | +5% | +19% | +20% | +19% | +17% | +20%
19. David Willetts -1% | -14% | +3% | +7% | +13% | +17% | +20%
20. Sayeeda Warsi -20% | -14% | -4% | -2% | +18% | +16% | +19%
21. Owen Paterson +10% | +9% | +16% | +17% | +18% | +15% | +15%
22. Cheryl Gillan +3% | +3% | +10% | +14% | +16% | +13% | +15%
23. Theresa Villers +7% | +5% | +9% | +14% | +14% | +11% | +14%
24. Patrick McLoughlin +9% | +2% | +27% | +28% | +29% | +10% | +14%
25. Theresa May +8% | +2% | +6% | +20% | +15% | +10% | +12%
26. Francis Maude -10% | -16% | -2% | +5% | +4% | +1% | +3%
27. David Mundell -6% | -11% | -3% | +3% | +2% | -2% | -1%

The above ratings are all monthly with the most recent on the right.  The ratings represent the percentage of members satisfied minus those dissatisfied.

Tories DO NOT plan to spend more on health than Labour

Lots of excitement this morning across the blogosphere about an interview that Andrew Lansley gave to The Times.  Both The Times and Telegraph have interpreted Mr Lansley's remarks as a commitment to increase NHS spending even faster than Labour and to increase spending as a percentage of GDP - perhaps by as much as £28bn.

This morning ConservativeHome has spoken to people in the health and Treasury teams - as well as CCHQ - and have been told that there are no plans for the Tories to spend more on health than is planned by Labour.  The Tory commitment is to match Labour until 2011 and further intentions have not been decided.

We've read and re-read Mr Lansley's remarks and can see why The Times made the conclusions that it did but are satisfied with the assurances we've received from party insiders.  As Peter Hoskin writes at Coffee House: "If ten years of Blair and Brown have taught us anything, it's that increased inputs don't necessarily equate to improved outputs. Today's National Audit Office report only serves to underline this."

What we're told Lansley does believe is that without big improvements in public health - Cameron has promised him that he will be Secretary of State for Public Health - and improvements in NHS productivity there is a real danger that the NHS will swallow up a much bigger slice of the national economy.  The aim, however, is to harness more private resources and know-how in order to help avoid this.

Lansley: It is still wrong to take organs without consent

BBC News is headlining Gordon Brown's surprising announcement today that he prefers "a system of "presumed consent" - where hospitals could take organs unless a person had explicitly opted out before death or their family objects".  The Prime Minister believes that thousands of lives might be saved by such a policy shift and he writes about the issue for The Sunday Telegraph.

Surprisingly Andrew Marr didn't ask David Cameron about the issue during their interview earlier.  Shadow Health secretary Andrew Lansley has just issued this statement, however:

“I urge people to consider organ donation and if willing, to put their name on the register. The Government’s responsibility is to encourage registration and ensure transplant co-ordinators and transplant nurses are in place so that when organs are made available they are used for transplants.  Only four years ago, Gordon Brown and Alan Johnson voted against assumed consent in organ donations on the basis that there was no public support, they said that there were better ways of increasing donations and that the State should not determine what happens to people’s bodies after death. Parliament concluded that to take organs without consent was wrong. It is neither right nor necessary for us to change that view”.

The Westmonster blog thinks that the spinmeisters who are allowing Brown to be painted as an organ harvester should be fired:

"The Prime Minister is plummeting in the polls. The government is seen as encroaching on civil liberties. So, two weeks into a new year "relaunch" seeking to revive his political fortunes, how does Gordon Brown want you to start out your Sunday morning? Naturally, by reading an op-ed in today's Telegraph announcing a new government programme to take your heart after you die, without your consent.  As comedian Jerry Seinfeld might say, "Who are the ad geniuses who came up with that one?""

1pm: Iain Dale's take - Brown Wants to Nationalise Our Bodies

Andrew Lansley will be Cameron's Secretary of State for (Public) Health

Louise Bagshawe will be pleased: David Cameron, interviewed on Today, stated that Andrew Lansley would be Health Secretary if he becomes Prime Minister at the next General Election.

The Tory leader was interviewed 24 hours after he promised to make the Conservatives the party of the NHS.  Asked if the wider Conservative Party was as committed to the NHS as he was, David Cameron replied that Mr Lansley was respected throughout the NHS, partly because he had held the portfolio for a number of years and that he would be Health Secretary in his first Cabinet.  Mr Cameron also paid tribute to the Conservative MPs and candidates across the nation who were campaigning to save local hospitals and A&E services.  The commitment to the NHS was "extremely great," he insisted.

As far as ConservativeHome is aware Mr Lansley joins George Osborne as the only other frontbencher who has been given a public guarantee of becoming the Cabinet minister for the job they currently hold.  Mr Cameron's tactics are unusual.  Party leaders normally like to keep their options open on appointments but Mr Cameron does not like reshuffles and strongly believes that frontbenchers should have time to master their briefs.  He attacked the frequency with which Labour has changed Health Secretaries.

Today presenter Sarah Montague's interviewing of Mr Cameron was typically lazy. It was all of the 'how can we sure that you've become centrist on the NHS?' variety.  There was no pressing of Mr Cameron from a reformist perspective - putting the hard questions to him on the need for more radical policy moves that would address the poor healthcare that Britons receive compared to most other advanced nations.  Not unfairly, Radio 4's Norman Smith said that there was now little to choose between Labour and the Tories on healthcare.

PlayPolitical one minute video: Cameron promises more choice to NHS patients and payment by results

11am: Iain Dale wonders if David Cameron has made a rod for his own back by giving this guarantee

Cameron renews claim of being the party of the NHS

David Cameron was in Manchester this afternoon to give his first big speech of the year, on the NHS. The NHS Confederation has already welcomed it. He then went on to welcome a LibDem defector as the first Conservative councillor in Manchester City Council since 1996.

Click here for a pdf of the full speech, or see further below for our compilation of the most interesting points.

Samuel was there and, after saying it was a very good speech, asked Cameron how the decentralisation agenda would square with some of the local Conservative campaigns against the closure of large hospitals. Cameron, who had explained in the speech how the NHS of old had come to be centred on a system of large hospitals, replied that decisions shouldn't be handed down from on high. Power should be given to GPs who understand what makes the system tick, he said, but he didn't agree with some Labourites that the days of the District General Hospital were numbered. He also said that as he had now had praise from ConservativeHome there was no need to carry on with the press conference. He did, however, continue with several more questions. We think he was probably just being polite by sticking around a little while longer.

Sefton Central candidate Debi Jones asked what a Conservative government would do to help hospices. Cameron said it was a great shame that many of them don't get any state funding, and Andrew Lansley said that money would follow the patient if they were getting treatment that the NHS would provide. A minister responsible for the Methodist churches and social action projects in the notorious Wythenshawe council estate spoke about all the things they do for the community, but also about how hard it was ("we almost have to deny we are churches") to partner with government bodies like PCTs. Cameron noted that he knew Wythenshawe well from some famous photos that may or may not have included someone in a hooded top. He was very sympathetic, saying that faith-based action should not be discriminated against in any way, and got applause with the joke: "take me to a humanist soup kitchen".

The issue of mixed sex wards was also raised, referring to the recent case of patient-to-patient sexual abuse in Manchester. Andrew Lansley said he had done some FOIs a few months ago that revealed that 30% of beds were in mixed wards, including 11% of planned admissions. He also quoted Tony Blair in 1996 saying that "it can't be beyond the wit of government to end mixed sex wards"! There were no press questions, perhaps they didn't fancy the trek up north so soon after New Year's Eve! Even so, Cameron said it was one of his New Year's resolutions to be nice to them - "let's see how long that lasts!".

We've made an at-a-glance version of the speech by splicing it up into all the key verbatim phrases, please click continue to read it...

The return of the Patients' Passport?

Against protests from David Davis, David Cameron rejected the Patients' Passport policy during the Tory leadership election... but is the idea about to return at the EU level?

Tory MEP John Bowis hopes so.  Speaking on the Today programme at 7.10am, Mr Bowis welcomed a Commission initiative (BBC report here) that could see a right to 'health tourism' introduced across the EU.  UK citizens could enjoy a right to receive treatment from a health provider in another EU state if it was at a similar cost and if the patient had experienced "undue delay".  Mr Bowis implied that the right might be enforced by European courts if Brussels did not act.

John Humphrys on Today implied that "the Tories" were in favour of this policy.  If so, that wasn't entirely clear from an exchange between Andrew Lansley and Health Secretary Alan Johnson in the Commons yesterday:

Andrew Lansley: "Will he say whether he will support or oppose the draft directive to be published by the Commission tomorrow, or is he frightened that, in addition to the £490 million extra that we already pay for British residents abroad or visiting other EU member states, many more will choose EU continental European health care in hospitals that perhaps have lower infection rates or lower waiting lists? Are the Government going to support choice for patients or oppose it?"

Alan Johnson: "The hon. Gentleman was doing well until the last bit. A couple of weeks ago, one of the Sunday newspapers took three pages to say that 70,000 people in this country had sought treatment abroad, when we treat 1 million people every 36 hours in the NHS. When one delved into the article, one found that those 70,000 wanted cosmetic surgery or cosmetic dental surgery that could not be provided in this country. It was portrayed as though people were, in the words of the hon. Gentleman, going abroad to escape long waiting times and get cleaner hospitals.  However, the start of the hon. Gentleman’s point was absolutely right. We have to consider the directive carefully. I have not seen its terms yet—it is not published until tomorrow—but I have made it clear to Commissioner Kyprianou, as has the Minister of State, my right hon. Friend the Member for Bristol, South (Dawn Primarolo), that we must maintain the crucial principle that clinicians will decide what treatment to give in this country. We need to ensure that the principles that have guided the system for many years are not sacrificed to something that might seem like a good idea for a European directive, but which reduces patient choice in the long run."

Labour are said to be resistant to a proposal that is still in very draft form and, if it happens at all, may be years away.  A NHS industry representative on Today said that there were many objections on equality grounds to the proposal.  To very easy questioning from Mr Humphrys he said that it would be a proposal that favoured the relatively young, mobile and rich.

9.30am: Fraser Nelson has posted on this topic: "The Labour left is angry about the rich escaping the NHS system by private insurance so you’d think they’d welcome the chance for the poor to do so as well. But no, they say this European plan threatens the foundations of their beloved NHS. I’d like to hear someone explain that to a patient. “Sorry Mrs Dickson, you’ll have to wait in agony for another year but your sacrifice helps protect the ideological integrity of the NHS”. It is a cause they are prepared for others to die for."

1.20pm: Fraser reports that Lansley is backing Brussels on this, apparently saying "What is the government so frightened about? Are they afraid of choice?"

Andrew Lansley proposes an independent NHS for England

Keeping up the momentum that has characterised the post-Blackpool Tories [we have also had announcements on English votes for English laws, a new emphasis on immigration and withdrawal from talks on party political funding] Andrew Lansley publishes a draft bill to make the NHS in England independent.  [Message to CCHQ: Nothing on conservatives.com about this as I write.  Time and time again the party website is behind the news].

You can read about the proposals at the BBC, Sky, Telegraph, FT and Guardian.  Andrew Lansley, who has been rising steadily in ConservativeHome's shadow cabinet league table, was also on the Today programme just after 7.30am.

Here are some of the Tories' key proposals:

• Two-thirds of the NHS' budget would be put in GPs' hands according to The Guardian.  GPs would decide which services would by provided at their own surgeries and which would be purchased from NHS hospitals and from private providers.
• An NHS Constitution would define the level of treatment that patients could expect and would include the idea that healthcare would be free at the point of use.
• A new independent health board that would take over the existing Whitehall Department's responsibilities and so free the system from "political tinkering".  Its responsibilities would include the allocation of resources, the setting of national standards of care and the issuing of commissioning guidelines.
• The Health Secretary would then become the Public Health Secretary - focused on issues like smoking and obesity.
• There would be a new body - HealthWatch - which would handle patients' complaints about treatment.

Labour Health minister Ben Bradshaw MP immediately rejected Tory overtures to help them implement the draft bill that could be introduced by the Opposition or an individual MP:

"It is simply wrong to suggest that taxpayers should invest £90bn in the NHS but there should be no political accountability for how that money is spent.  Under Tory plans, ministers would be powerless to intervene where a hospital is failing."

Birmingham University's Professor Chris Ham, the former head of the Department of Health's strategy unit, told the FT that while the "details differed considerably, the thrust of the Conservatives' bill would have produced similar results as Blairite reforms".

What should Conservatives do about obesity?

Yesterday in the Commons, Andrew Lansley set out the Conservative approach to Britain's "obesity crisis" - a crisis that is projected to soon account for more premature deaths than smoking.  Last weekend's Observer presented a nightmare scenario of £45bn in social costs by 2050: "Soaring rates of diabetes, strokes and heart disease caused by more Britons becoming fatter will cost the NHS alone £6.5bn".  These sorts of projections should always be treated with a pinch of lo-salt but, putting aside the hyperbole, most agree that there is a real problem.

Mr Lansley, Shadow Secretary of State for Health, said that Britain needs "a supply chain initiative that will reduce fats, sugar and salt progressively and substantially."  "We must also promote good diet, he continued, "targeting certain junk foods".

Mr Lansley also called for:

• "A combined traffic light and Guideline Daily Amounts labelling scheme?"
• "A national research centre on obesity"
• "A nationwide programme to identify cardiovascular risk"
• "Ring-fenced public health budgets so that we cannot carry on seeing such budgets being raided to meet national health service deficits".

Mr Lansley attacked the Government for halving the number of public health professionals and for halving lottery funding for community sport "when half the population do no sport and take no active recreation".

It is not just UK Conservatives who are taking obesity seriously.  One of the Republican candidates for the US Presidency has also been an interventionist on public health.  This is what Mike Huckabee, Governor of Arkansas, said at the beginning of last year:

"I don't want to be the sugar sheriff.  I don't want to be the grease police. That's not my job. But when I look at our state budget, and I see that every year our Medicaid budget is increasing by 9 to 10 percent, and I look at state employees' health plans and I see that those costs are escalating at double digits and twice the rate of inflation — as a fiscal manager, I have not only the right but frankly also the responsibility to see what can we do to improve this bottom-line cost."

It's easy for libertarian Tories to say that it is no business of the state to try and influence what people eat but what is their solution to the obesity challenge?  Obesity, family breakdown and drug addiction are some of the bigger drivers of the growth in the size of the state.  Do we act against these drivers now or do we wait and pay later?

'Duracell Dave' should campaign on crime and the NHS

Remember this edition of The Guardian from February?  That was when all of the newspapers were in a herd-like rush to say that Brown couldn't beat Cameron.  Seven months later and we wake up to a very different Guardian splash...

The Guardian/ ICM poll shows that Labour has re-established a lead in all of 'the battleground issues'.   Its smallest lead over the Tories is 1% (on asylum and immigration); its biggest lead is 25% (on overall economic management).

A Populus survey for The Times (of just 504 voters on Monday) finds that the Brown-Darling lead over Cameron-Osborne has actually grown since the beginning of the Northern Rock bank run.  Labour had a 61% to 27% advantage before the 'crisis' but a 56% to 18% lead now.  Labour's standing has fallen but Cameron-Osborne have fallen further.  A leader in The Times describes the Conservative response to the banking saga as "intellectually lamentable and politically misjudged".

Last night's ToryDiary thread - below the news of Labour's 8% lead - had the smell of defeat about it.  It was more depressing than the poll itself.  Let's get things into a little more perspective.  Here are a few thoughts:

• The two Guardian frontpages show that things can change.  Brown had been written off but he's now - apparently - unbeatable.  The media over-interpret most things and I don't think Brown can take the next General Election for granted.  Even the biggest critics of Cameron should at least put some hope in events!
• Last week I predicted that Labour's lead would widen a little.  We had dominated the headlines in the second half of August and Labour had had the better of the news cycle since.  Labour's lead - according to ICM - has grown from 5% to 8% as a result.  Disappointing but not a seismic shift to Labour.
• Things might get a little worse yet.  We're in the Conference season which always distorts opinion polls.  The LibDems will get a boost after their Conference.  Labour will get a boost after theirs - particularly if Brown finally makes some big policy announcements that have so far been missing from his 'change agenda'.  The polls during the weekend that Conservatives gather in Blackpool might be particularly depressing but we must hold our nerve and wait for real public opinion to become clear towards the end of October.
• Some of you might fairly comment that we might not have until then.  Brown might have called an election before the end of October.  A unnamed Cabinet minister told Telegraph.co.uk that there was anything between a 30/70 to 40/60 chance of it happening.  He/ she might be behaving mischievously but, on balance, I still expect an autumn poll (and have done since the new year).  I have bet lunch with Ben Brogan that there will be one although I hope he's right and I'm wrong.  The critical thing is that CCHQ and all candidates are ready to campaign like they have never campaigned before should Brown blow the starting whistle.
• In terms of campaigning I suggest two main themes: crime and the NHS.  When David Cameron campaigned on crime and social breakdown in the second half of August we won excellent coverage and the polls tightened.  The big theme of the Blackpool Conference should be crime.  Crime - more than any other issue - is where David Cameron has perfectly blended a traditionalist approach (more prisons, honest sentences, no early release, scrap the Human Rights Act, stricter classification of cannabis...) with his progressive conservatism (ending educational failure, fixing the family, more drug rehab, more support for social entrepreneurs...).
• The NHS should also be bigged up.  Too many voters fear the Conservative leader is too much of a PR guy.  David Cameron is genuinely committed to the NHS and it shows.  Let's have more of that passion and commitment.
• Finally there is the issue of 'Duracell Dave'.  Our leader has hardly stopped over the last month.  He couldn't have worked harder over the last few weeks.  He's given speeches, announced new policies, been interviewed on every platform from This Morning to Today to The Telegraph website.  Jonathan Freedland makes the Mike Smithson point this morning that the more David Cameron is in the media the better the Tories do.  Despite this morning's poll I think there's a lot of truth to that.  David Cameron has given 110% in recent times.  Other members of the frontbench now need to do much more, too.  We need more Chris Graylings and where is Caroline Spelman?  Can anyone remember her doing anything since becoming Chairman?

And - please everyone - let's not have another Chicken Licken thread.  Is it too much to ask to try and have a positive, constructive discussion?

"Restoring Pride in Our Public Services"

The Conservative Public Services Improvement Group led by Stephen Dorrell MP and Baroness Pauline Perry published its report this morning at the Policy Exchange's Ideas Forum.  There are more than 150 proposals on education, social housing and health.  These are the main ones:

On education

• Establish a Chief Education and Skills officer and a Royal College of Teaching, along the lines of their counterparts in the NHS.
• Reduce the volume of guidelines for schools.
• Abolish "AS" levels
• More disciplinary measures, clearer exclusion powers, anonymity for teachers subject to allegations.
• An "advantage premium": additional per-capita funding for pupils from disadvantaged backgrounds.
• Encouragement for more academic charities to run city academies.
• Provision of buses to transport children from over-subscribed to under-subscribed schools.

On social housing

• Provision of 10% equity for social housing tenants after five years good behaviour.
• Review of social housing waiting list policy
• "Commitment to mixed communities", i.e., seeking varied incomes, tenures, demographics and ethnicities, subject to local circumstances, as a way to avoid concentrations of deprivation.
• Creation of a national affordable housing fund.
• Measures to make the Right to Buy "more affordable" by altering discounts.

On health

• "Less political interference in the day to day management of the NHS"
• "Greater freedom for individual healthcare professionals, in return for
  clear accountability for outcomes"
• "A service which puts patients before bureaucrats"
• "Greater emphasis on public health objectives", improved powers for the Chief Medical Officer and "separate public health budgets"

Read and debate the report at Stand Up Speak Up.

Thomas Cahill

Stephen Dorrell urges trust in renewed public service professionalism

This Thursday will see the fifth Conservative Party policy group report.  [11.45am: Sensibly, the report has been rescheduled to the following week]. Stephen Dorrell and Baroness Perry will present their proposals for modernising Britain's public services.  As with the competitiveness and social justice reports we can expect to see individual ideas trailed in the press on a day-by-day basis.  The report will have to compete with a news agenda that is heavily focused on the consequences flowing from the shooting of Rhys Jones.  As Matt d'Ancona writes in today's Sunday Telegraph - and as ConservativeHome urged on Thursday - Mr Cameron's social responsibility agenda may have found its moment.

But back to public services for now and an important op-ed by Stephen Dorrell in The Sunday Times.  Mr Dorrell, Health Secretary under John Major, attempts to pre-empt claims that his plans to entrust professionals amount to 'producer capture':

"The case for strong and independent professions is not the case for a return to the status quo ante. It is the case for challenging the professions to accept their responsibilities – to acknowledge that they, and they alone, are able to ensure the reality of public service excellence matches the rhetoric."

Mr Dorrell argues that measures to counter the poor professional standards of the past - measures including waiting time targets in the NHS and literacy and numeracy hours in schools - brought short-term benefits but their "inevitable long-term consequence [is] that discretion is drained from professional structures and centralised in the hands of interventionist ministers."

He says that Britain can choose to continue to impose "an increasingly arcane set of bureaucratic measures and targets, or it must seek ways of reengaging with the aspirations and idealism that originally motivated the vast majority of professional people to devote their lives to their profession."

Mr Dorrell argues that this is no choice at all.  Whilst accepting that patients and pupils must be free to move from one hospital and school to another he sets out principles for renewing public service professionalism: 

1. "The professions must be engaged in the management of the services. When professional people experience management as an activity “done to them” rather an activity in which the profession itself is engaged, it becomes too easy to reject management objectives as service distortions.
2. Public services need to develop more reliable and publicly available outcome data – including data related to the performance of individual professionals – to allow all interested parties to see the evidence about performance.
3. The professions need to be engaged in the preparation of the outcome data in order to reduce opportunities to discuss the preparation of the statistics instead of the facts they reveal.
4. The leaderships of the professions need to develop the stature to act, locally and nationally, as both effective advocates for the professions and effective monitors of standards."

The advance publicity for the Dorrell-Perry report also begins today with a story in The Observer.  In an idea very similar to that proposed by Iain Duncan Smith, the public services policy group will say that parents should have the power to set up new schools to rival those of local education authorities:

"In areas where schools are performing badly, the councils should have no power to stop such a move, a Tory policy review will recommend this week. Co-chaired by former cabinet minister Stephen Dorrell, it will argue that forcing local authorities to fund the schools would boost exam performance."

Is a clerical error at CCHQ more newsworthy than the lowest cancer survival rates in Europe?

I'm about to go and do BBC News 24 on the hospitals row.  In case you hadn't heard, the Tory list of district hospitals threatened with closure wasn't 100% accurate.  Most unhelpfully a Conservative MP, Henry Bellingham, has criticised the placement of his own local hospital on the list and this has got the BBC very excited.  It's obviously a mistake that shouldn't have been made.  One of the few things an opposition party can control is competent management of its own affairs.  The bottom line, however, is that the Tory campaign on NHS cuts is staying in the news.  My guess is that more voters will be left angry at Labour's mismanagement of the NHS than will be concerned about a clerical error in CCHQ.  A clerical error is certainly much less significant than the news that - ten years into Labour rule - Britain has one of the lowest cancer survival rates in Europe.  My understanding is that the new CCHQ list may identify more hospitals at risk of closure or facing cuts.

By way of footnote: When I was at the Bank of England there was a 'done by, checked by' or 'four eyes' rule for the drawing up of any public document.  CCHQ should adopt the same rule.

4.25pm: Reform have a briefing on Britain's woeful record on cancer.

Cameron to target waste in the public services

As ConservativeHome reported last week David Cameron will be putting the NHS at the heart of his attempts to convince people that the problems voters had associated with the Blair-Brown years will continue so long as Gordon Brown remains in government.  The Guardian reports that David Cameron will visit a hospital in Worthing today and in the West Midlands tomorrow. Interestingly, the Conservative leader is going to link the problems of the NHS with the government's failure to spend taxpayers' money well.

The Tories first made this kind of link during the 2001 campaign with the 'You've Paid The Tax' poster campaign (three examples of which are below).  Taxpayers then were unpersuaded that government had wasted their money.  Times have moved on with much greater appreciation of the extent to which the government has wasted taxpayers' hard-earned money.  The TaxPayers' Alliance and the Burning Our Money blog have done a great job at helping to drive this change in public mood.  Perhaps its time for CCHQ to revive a version of the 2001 campaign?

David Cameron to put healthcare at the heart of his fightback

David Cameron returns from his holiday this weekend, hopefully rested and ready to launch his fightback.  The latest opinion polls suggest a widening of Gordon Brown's lead over the Conservatives and today's Daily Mail reports that steel tycoon Lord Paul - worth £280m - has said that he'll give as much as he can afford to fund any autumn General Election.  Paul donated £45,000 to Brown's leadership campaign.

ConservativeHome has learnt that the NHS will be at the heart of David Cameron's fightback.  The Conservative leader believes that the NHS - to which he has a deep personal commitment because of the way that it has cared for his son, Ivan - is Gordon Brown's Achilles heel.  Over the last year the Conservative Party has earnt considerable support from healthcare professionals and has held successful NHS action days in constituencies across the country.  The campaign may include a series of hard-hitting advertisements as part of the long-awaited summer offensive.

Mr Cameron's emphasis on healthcare will please project loyalists like Nick Gibb MP who worry about Labour's taunts that the party might be 'lurching to the right'.  Mr Gibb has told ePolitix.com that Mr Cameron should stay on the modernisation path: "I think he's just got to stick to his plans which is to modernise the Conservative Party, which is indeed what he is doing, and to ignore any bubbling of dissent."

Modernisers and some traditionalist MPs are also worried about this week's focus on John Redwood's recommendations for deregulation.  They fear that the recommendations have come out of the blue with inadequate preparing of the ground.  Mr Redwood will explain his report on this website on Friday in an article for the Platform.

Could a junior doctor be the next MP for Sedgefield?

That is what Vicky Ford is wondering.  A junior doctor campaigning against Labour's NHS record could win the seat Tony Blair is about to vacate but only if the other parties give him or her a free run.  Intriguing thought.

9.45pm update: Graham Robb selected for Sedgefield

David Davies MP: Charge foreigners for using the NHS

This from Mr Davies on today's Cornerstone blog:

"The government funded “Visit Britain” website which is supposed to generate money for our nation, actually advertises to the world that “you are eligible for free emergency treatment in the Accident and Emergency departments of National Health Service hospitals.”! It goes on to state that foreign visitors (with many exceptions) will be charged for after-care. But of course nobody ever pays. An official might make a half-hearted attempt to chase up a large debt from someone living in the third world who has given a false name and address. He or she will fail...

A simple measure would put a halt to much of this abuse. We should insist that absolutely everyone arriving here from outside the EU, should be in receipt of a verifiable health insurance document that could be checked by immigration officials.  At a stroke we would put an end to a great deal of freeloading on our public services.  The idea is so simple it needs no more than a sentence to sum it up. It would be fair and would do no more than to bring Britain into line with the rest of the world. It would save the NHS tens of millions of pounds each year which could instead be spent treating British patients."

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Earlier today we highlighted the Conservative priorities for the NHS.

Conservative priorities for the NHS

The new health policy from the Conservative Party aims to redress the problems in the NHS by:

• Ensuring that money put into the NHS goes into improving the NHS for everyone and is not wasted on red tape and pen pushing.
• Ending the top down target culture and taking Ministers out of day-to-day decision making in the NHS.
• Giving patients more information and choice.
• Ending pointless reorganisations in the NHS.

As part of their policy the Party are making three core commitments:

• "We will write into law the underlying principle of the NHS that all people will receive universal access to a comprehensive health service based on need and not ability to pay.
• "We will ensure that public funds for health care are devoted solely to NHS patients; we have ruled out subsidies to private health care.
• "We will not sanction any more pointless reorganisations of the NHS. The proposals in our White Paper are based on existing structures."

The policy proposes that the Government remain responsible for establishing the framework in which the NHS operates and for setting overall spending and objectives but that an independent NHS board will allocate money.

Targets will be abolished and decision making (and budgetary) powers will be put in the hands of doctors, nurses and other healthcare professionals. Patients will be given more choice and doctors and nurses will be more accountable to patients.

The NHS will also be accountable to local councils for the structure of health services and the priorities of the local NHS.

You can read the policy proposals here.

Hospital SOS

This video shot by ConservativeHome from a helicopter on Sunday shows a massive protest against the closure of key hospital services in Grant Shapp's constituency:

Grant set up Hospital SOS and it now has cross-party support locally and thousands of supporters (it took a thousand just to form that sign). This rapid mobilisation of grassroots groups is getting easier and easier to organise with the internet. A couple of weeks ago I cycled into a huge routeless cycle protest blocking the roads in Westminster, it was entirely organised through a campaign website and on Facebook. Flashmobbing often brings thousands of strangers together at very short notice to do an unusual act in a public area, such as a pillow fight or silent rave.

The catalyst for this is the ease with which anybody can film something and put it on YouTube for the world to see, these events are full of people holding cameraphones and camcorders.

Very aptly, I'm off to a Bebo conference on Politics 2.0 this morning. Joe Trippi, the author of "The Revolution Will Not Be Televised: Democracy, the Internet and the Overthrow of Everything" and the campaign manager for Howard Dean's famous internet-driven presidential campaign, will be speaking.

Deputy Editor

Osborne prepares to paint Brown as lurching to the left

Shadow Chancellor George Osborne will give a major speech to Policy Exchange later today in which he'll attempt to revive the idea that Gordon Brown is a serious roadblock to reform.  He will test the patience of some Tory supporters by welcoming the suggestion that the Tories are the true heirs to Blair when it comes to public service reform but he'll also play hard politics by accusing Gordon Brown and Labour's deputy leadership candidates of abandoning choice and private sector involvement in their approach to public sector reform.

Mr Osborne will say:

"This growing consensus between the current Prime Minister and the Conservative Party does not appear to include the next Prime Minister.  And therein lies the political battle ahead, for Gordon Brown rejects the very idea that there should be alternative providers of taxpayer-funded public services... The difference now is that the people around Gordon Brown are also making the case against choice and diversity, and challenging key aspects of the Blair settlement."

In recent days we have seen Peter Hain talk about the limits to public service reform and Alan Johnson threaten the charitable status of private schools.  During last night's Newsnight debate amongst the deputy leadership candidates we saw Harriet Harman lead the 'leftwards lurch' with calls for an amnesty for illegal immigrants and more redistribution.  She said:

“We are not just worried about where the bottom is in terms of poverty. We are worried about the gap with rich and poor. You can’t have proper equality of opportunity with a huge gap between rich and poor. Do we want to be a divided society where some people struggle and others spend £10,000 on a handbag?"

John Cruddas - who endorsed Ms Harman in the race should he not be successful - endorsed the idea of higher taxes “for the David Beckhams of this world."

ConservativeHome will be at the speech and will post a full report later today.

David Cameron's press conference

In opening remarks the Conservative leader, standing near a large picture of Winston Churchill, focused on the Blair-Brown transition and the NHS.

He said that Gordon Brown's "non-election tour" was bad for Britain.  Given that the "Prime Minister non-elect" was not going to face a challenge he should become Prime Minister immediately.  The circumstances had changed since the Labour Party had chosen a seven week leadership campaign and now Tony Blair's departure date should change, too.  It was "bad for Britain" that lame duck ministers like Patricia Hewitt were staying in position while the NHS was facing such difficult circumstances.  It was a farce he said that Tony Blair - because of vanity - would be representing Britain at global summits when all other leaders really wanted to sit down and get the measure of Gordon Brown.

Standing alongside Shadow Health Secretary Andrew Lansley he went on to propose a seven point emergency plan for the NHS:

1. An immediate end to the closures of A&E and maternity services that were being driven by short-term financial considerations rather than long-term clinical considerations;
2. More training posts for junior doctors;
3. An independent review of the NHS supercomputer debacle;
4. Re-engagement of GPs with the Department of Health for discussing the future of contracts;
5. Abolish central targets that undermine the professionalism of frontline doctors;
6. A new fairer funding mechanism that recognises the distribution of disease and clinical need;
7. Acceptance of House of Lords amendments to the Mental Health Bill.

Then the questions from the press started and 13 of 17 were about education and grammar schools, in particular.  Nothing much new was learnt with Mr Cameron continuing to insist that the debate was "pointless".  He slightly dodged a question from Nick Robinson in which the BBC Political Editor asked if any frontbencher had threatened to resign.  Mr Cameron replied by saying that no shadow cabinet member had threatened to quit.  He also said that he had not spoken to Michael Howard since the beginning of the row.

Other interesting answers to questions:

• There were no plans to restore the assisted places scheme;
• He would be visiting America soon but had no plans to visit President Bush - it was better that Britain was America's best friend (and was candid) rather than acting like America newest friend (and too eager to ingratiate itself);
• He personally opposed the David MacLean bill.

David Cameron's performance was flawless - perfectly articulate and controlled.

Big increase in Tory support among doctors

Labour's claim to be the party of the NHS is goundless.  That's the view of Shadow Health Secretary Andrew Lansley after a poll of doctors found that just 7% intended to vote Labour at if a General Election was held this year. The poll of 1,442 doctors (carried out by Hospital Doctor magazine and Medix) found that support for Labour was down 17% compared to the last Election and support for the Tories had increased by 16%.

Andrew Lansley:

"Doctors at the heart of our services are not only suffering poor morale but have now lost confidence in Patricia Hewitt and Labour’s stewardship of the NHS. In the two years since the General Election there has been a huge swing from Labour to the Conservatives.  Health professionals have heard David Cameron and I put the NHS at the forefront of Conservative priorities. They have heard us commit the next Conservative Government to a new partnership with health professionals and a NHS with is focused on patients’ interest not politically driven targets."

A less positive assessment of the reasons for the increase in support (written before the poll was published) comes from Fraser Nelson in The Business:

"In health, the party has assuaged the doctors’ and nursing unions by promising independence for the NHS bureaucracy and freedom from government reform with an “NHS Independence Bill”. It is a recipe for stagnation; the problem with the £106bn ($209bn, E156bn) NHS system is that it concentrates power in the hands of bureaucrats rather than patients... In health, the deeply unimpressive Andrew Lansley has treated his job as the Tory ambassador to the doctors’ unions. There is strategic advantage in campaigning against Labour’s tough decisions to reign in NHS spending: the Tories can pose as opponents of hospital ward closures, and thus attack Labour from the left."

Labour are about to trash the careers of 8,000 junior doctors says Mark Fulford on YourPlatform.

Notes from Nottingham

William Hague's speech: A few weeks ago I wrote for The Guardian's Comment is free and welcomed the more balanced Conservatism of recent months.  The messages of modernisation are being blended with grittier messages on Europe, tax and crime.  'The politics of and' is certainly on show here at the Nottingham Spring Forum with much emphasis on the NHS and crime... on greenery and the importance of the family.  This is what William Hague said earlier today:

"So when some commentators write that the Conservative party should simply stick to its well-worn grooves, I say they're wrong. I say the challenges we face are so great, that party loyalties among younger voters are so weak, and that the failure of Labour across the board is so absolute, that the time has indeed come for us to fight with as much confidence for a cleaner environment and a better health service as we have always fought for strong defence and fairer tax. That our task is to show that social responsibility, bringing out the best in families and communities and not just relying on the state, is the only way to face the great social and environmental crises of our time."

Mr Hague (under a little fire for his outside interests) used his speech to set out five broad principles to guide Conservative foreign policy:

1. The return of Cabinet-style foreign policy decision-making - in contrast with Tony Blair's "decade of sofa-style decision making";
2. For Britain's "permanent friendship" with the USA to be coupled with "honest criticism" but nothing to disrupt the  diplomatic, intelligence and security links between our two nations;
3. Greater investment in relations with the Asia-Pacific region with "much increased attention on the many friendly nations of the Middle East";
4. Reform of multilateral institutions  EU, NATO and the UN;
5. A defence of our basic values across the world - "a strong attachment to human rights, a belief in the rule of law, the defence of political freedom, the promotion of economic liberalism, and humanitarian intervention when it is sensible and practical."

George Osborne's speech: The Shadow Chancellor gave an upbeat assessment of the party's prospects in his address:

"You wouldn't have believed me if I'd said to you, back in the days after our last election defeat, that less than two years later we would be ahead of our opponents, in command of local government, dictating the political pace and, above all, setting the agenda of ideas.  But we are, thanks to you, thanks to our courage to change, and thanks to David Cameron - who has defied the armchair critics, stuck to his guns and put us in a position where we can now win the next General Election."

He called on Gordon Brown to put the NHS at the heart of Wednesday's Budget:

"In every part of this country there are local hospitals facing closure, nurses facing the axe and junior doctors left in limbo.  The chancellor's financial mismanagement has led to ward closures, job losses and patients travelling further for their care.  So Gordon Brown should make Budget Day NHS Day.  He should set out the National Health Service's budget for the next three years, so the health professionals can start to plan for the long term now.  We've already had the three-year budgets for the Home Office, the schools capital budget and the Treasury itself.  So why not the NHS? He must have done the sums. Let's have them."

Liam Fox on defence: The Shadow Defence Secretary spoke to a gathering of Conservative Future about defence policy (at 36 I probably shouldn't have been there).  Dr Fox addressed the issues of energy security, the rise of Russia and the threat of Iran-driven nuclear proliferation.  And, in the best line of Conference so far, he noted that hawks tended to live a lot longer than doves.

"New priorities for a new era"

The above graphic is a scan of the programme for this weekend's Tory Spring conference in Nottingham.  Robert Halfon, our candidate in Harlow, compared the five key themes to the ten words which Michael Howard employed at the last General Election.

Of the new five themes it seems that "better public services" will be topping the agenda in Nottingham and healthcare, in particular.  David Cameron will address a rally of thousands of junior doctors in London this morning, according to The Telegraph, and Andrew Lansley yesterday announced a major emphasis on public health that reminds The Telegraph of Sir Norman Fowler's late 1980s public health campaign against AIDS.  The Tories want to move the heathcare system to a much greater focus on prevention and the Health Secretary will be renamed Secretary of State for Public Health.

10.30am update: According to the Nottingham Evening Post - in line with the "safer streets" theme - we can expect a big emphasis on policing: "David Cameron would like an elected mayor or police commissioner to run Nottingham's police force.  The Tory leader wants to see a direct line of responsibility for crime fighting, similar to that which has proved successful in US cities, like New York. At the Conservative Party Spring Forum, which begins in Nottingham today and will attended by 2,500 Tories, Mr Cameron will outline a "radical reform" of policing."