A Government worth having: Health policy

In the latest of our 'A Government Worth Having' series we look at health policy.  Top-up payments, patients being able to choose their healthcare commissioner and strong Matron-like figures are just three of the ideas suggested below. We've previously looked at new directions on economic and foreign policy as part of this series.

Simon Chapman: "The next Conservative government will have to face up to the overwhelming pressures that the NHS faces: demographics, dementia, obesity, technological and treatment advances, and rising expectations. These are already upon us and will only increase.  We will spend over £100 million on the NHS next year. That is highly political. At the moment there is no direct democratic accountability. An unelected NHS Board won’t make that better.  Tax funds are already insufficient to meet demand, although there is undoubtedly room for more effective spending. Decisions about priorities and rationing should be brought as close as possible to the people affected by them. Personal budgets (vouchers) and locally elected health boards are the levers. Co-payments are also inevitable.  Health reform must become a first term priority. The public are ready for honesty and candour – certainly more eager than the current Westminster consensus is prepared to allow.  We need to close the gap between health and social care. Joint commissioning and pooling budgets is one way forward. Bringing both under the strategic responsibility of one department is another: how about changing Andrew Lansley’s job title to Shadow Secretary of State for Health and Social Care? Before anyone shouts, I know that Local Authorities are responsible for social care, but they could be made accountable to a different Secretary of State.  Finally, if we want to improve confidence in the NHS, we need to make end of life care more of a priority. Over half of all deaths occur in NHS hospitals, and over half of all complaints about NHS hospitals concern dying and bereavement care. Hospices are often superb, but they cannot provide a complete answer."

Nadine Dorries MP: "I trained in an NHS which was run with consideration and discipline. The first concern of any nurse was to reassure her patient. To be aware that a hospital was a scary place, that we knew most things weren’t going to hurt and would probably be ok, but that the patient didn’t.  As a night nurse I spent many an hour sat on the edge of the bed of a sleepless worried patient, with tea and toast, listening to the dark worries keeping my patient awake. How long will I be off work? Will this affect my life?  I worked on wards which had dedicated ward cleaners and Auxiliary nurses who took pride in their wards and were in silent competition with the cleaner on every other ward in the hospital.  Nurses never wore their uniform outside of the hospital. A plastic apron was donned every time you treated a patient. Hand washing was automatic, cleanliness imbued throughout every aspect of the ward day. Visitors limited in order that a ward could be properly cleaned. There was no MRSA and poorly patients got the rest they needed.  Matron ruled, Doctors trembled, no nurse failed to give anything but her best. Everyone was accountable via a very clear line of command. Everyone knew who was responsible for what and when.  The NHS of today is driven by targets and process, not patients. Sometimes it feels as though patients are an inconvenience, lying in the way of clipboards and men in suits.  We need to make healthcare delivery totally patient focused. By remembering patients are there because they are vulnerable and ill and by giving patients respect and putting them at the top of the NHS agenda, by removing business suits and replacing with caring  uniforms, we may just begin to see a shift of priorities."

Andrew Haldenby, Director of Reform: "The issue of top-up payments for NHS care is waiting to be grasped by Government or Opposition.  This year a series of cases have proved that the existing rules are a classic example of how bureaucratic inflexibility can become cruelty.  Currently Norman Lamb is the only frontbencher spokesman who has argued for change bravely and positively rather than reluctantly.  A majority of patients and doctors are in favour.  Allowing patients to top up would be directly in line with the modern Conservative ideas of social responsibility and the post-bureaucratic age."

Dr Rachel Joyce, our PPC for Harrow West and a former PCT Director: "The NHS internal market failed because the “commissioner” is a poor proxy for the patient. Bureaucratic rules and targets make meaningful clinical and patient involvement in commissioning impossible, leaving managers to make decisions on what services are provided for patients.   “Successful commissioning” in the NHS is judged by performance against targets and rules. Success, in contrast, as judged by a patient is on good clinical outcomes and convenience.  Therefore much of the increase in health spending has been wasted on the administration of targets, resulting in high comparative costs but poor outcomes.  Patients should be able to choose who commissions their care. If GPs could choose their commissioning organisation, then patients could choose their GP practice (and therefore their commissioner) on the basis of outcomes. An independent NHS Board could be responsible for monitoring outcomes and quality via agreed indicators.  Patient choice of commissioner would drive down unnecessary bureaucracy and inefficient care, and would enable the NHS to provide comprehensive care that is not only efficient, but has world-class outcomes. "

Simon Chapman: The Fox Factor

Simon Chapman was a barrister for 12 years and now works in the voluntary sector for a leading national charity. He stood in High Peak in the 2001 General Election. This piece is his own view and has not been seen by the Fox campaign.

Talking about the Conservative Party’s need to change is very easy. Actually changing it is rather harder. It’s the difference between talking the talk and walking the walk. One candidate, Liam Fox, has done it. He has used both his campaign and his job as Shadow Foreign Secretary to challenge perceptions of what it means to be a Conservative, and to change the Party for the better.

He has put Human Rights, democracy, fair trade and the rule of law at the heart of Conservative foreign policy. He has established the Conservative Human Rights group, demonstrating that commitment to Human Rights is not the monopoly of the left. He has set out a fresh and optimistic vision for Britain’s relationships within the EU, pledging himself to build alliances with emerging politicians in New Europe and promising an end to the Conservative attachment to the EPP – a grouping which has been entirely inconsistent with settled Party policy. He is global in outlook and has urged the EU to look beyond its boundaries to the rest of the world, supported Turkey’s accession to the EU, spoken out for the oppressed people of Burma, called for long-term structural reform in Africa, and made a well-received speech on the opportunities and challenges posed by China’s emerging economy. He has reaffirmed Conservative Atlanticism.

In a few months he has transformed Conservative Foreign Policy, an achievement which has been recognised and applauded across the Party and beyond. Whatever job he holds after the leadership contest, he has built a legacy which I hope will shape Conservative and Britain’s foreign policy for a   generation.

As a leadership candidate, he has spoken directly to the British people, understanding that the electorate is entirely disenchanted with the spectacle of Conservative politicians talking endlessly to themselves about their need to change-and-reach-out, without ever getting round to doing it.

His vision for our nation stems from a Conservatism that combines his cheery optimism and love of this country with a rigorous and unflinching analysis of the challenges and problems that face 21st century Britain and a burning compassion for the people and communities that have been so damaged by long years of failed social policy.

His decision to make Britain’s “Broken Society” a key theme of his campaign shows that he realises that conservatism must be and always has been about more than merely economics. He has started to create a new language for conservatives: “broken society” is the most vivid and memorable phrase of this contest. His speeches on domestic violence and mental health (a long-standing concern of his), push the Party well beyond its comfort zone, and make casual stereotyping of his politics impossible. When it comes to economic policy, he is unabashed about promoting a clear prosperity agenda. His body of speeches this summer, and not least his conference speech, have been the most substantial of any of the 4 leadership candidates. He was the only candidate to launch his campaign outside the Westminster village.

Liam combines youth with experience. He became an MP at the age of 29. By the age of 34 he had served as a whip and a junior minister in the Foreign Office. He has been in the Shadow Cabinet since 1998. He is an excellent communicator, and has won approval from many media commentators and papers, including such diverse papers as the Sun and the Independent. He is still only 43.

Leadership is above all about character. I have touched on Liam’s already. He is warm-hearted, cheerful, generous and optimistic. His conduct of his campaign has demonstrated that he is principled, courageous, and passionate to make Britain a better place in which to live, work, bring up a family, and grow old. He has integrity, perseverance and vision. He has the intellectual clarity and self-confidence of a man who values ideas, has thought deeply about his beliefs, and is comfortable in his own skin.  Under his leadership the Conservative Party will re-discover its self-belief, without which it will never return to power.

Liam’s campaign has been substantial and impressive. He has defied expectations, broken new ground, and won fresh admirers – just as the Conservative Party needs to do. He has led by example. It is a campaign I am proud to have supported. He deserves to win, and I believe that he will.

Other Platform contributors have endorsed David Cameron and David Davis.  If you would like to make the case for Ken Clarke please email [email protected].

Simon Chapman: Rights, Freedoms, Entitlements and Obligations

'Platform' is a new place for guest authors to discuss important ideas.  To launch 'Platform', Simon Chapman, a regular commentator on conservativehome's leadership blog, has written this short essay on 'Rights, Freedoms, Entitlements and Obligations':

One consequence of the Human Rights Act is that a great deal of public debate is now conducted by reference to “rights”. All too often the last resort of somebody on shaky ground is to assert that he is claiming “a basic human right”, as if that is somehow unanswerable.

Conservatives are generally alert to this. But we have not yet found an effective way of countering rights-based arguments. Our two main tactics – a simple denial that such a right exists, or a call for the repeal of the Human Rights Act - can lead us into confusion.

A good recent illustration of the latter came in an otherwise compelling article by Lord Tebbit in the Telegraph:

“At the heart of Conservatism is the belief that, since man is born free, laws can only make him less so. "Human rights" legislation, for example, can only impose obligations.”

This contains both an example of error, and the kernel of the solution.

First the error. It is simply wrong to say that Human Rights legislation can only impose obligations on people. For example, Articles 9 and 10 of the convention recognise freedom of thought, conscience, religion and expression. No obligations imposed on anybody else there.

However, it is also undeniably true that some “rights” do impose an obligation. A “right” to education imposes an obligation on somebody else to do the educating.

The key to it is that there are two sorts of “rights”: those that impose an obligation on somebody else to provide, and those that do not. They are significantly different, and yet we use the same word to describe them. Herein lies much confusion. So we need a clearer language.

All “rights” fall into one of two mutually exclusive groups: “freedoms” and “entitlements”. A freedom imposes no obligation on anybody else. Freedom of speech, conscience and association can all be exercised without requiring anybody else to do anything at all. In contrast, entitlements always impose an obligation on somebody else to provide them.

Understanding this helps us separate “rights” debates into arguments about freedoms, and arguments about entitlements and obligations. This is more familiar ground for conservatives.

Two points need to be emphasised here. The first is that whilst freedoms need nobody to provide them, they often need people to protect them, because other people seek to take them away. They do not come without a cost. The second is that not all entitlements are automatically bad. Some are very important – and are the flip-side to our freedoms. Two examples of this are the right to vote and the right to a fair trial. Both are examples of entitlement “rights”. Laws to establish these entitlements are essential to bolster our freedoms, even though they impose obligations.

This is not purely a matter of semantics. Dividing “rights” in this way enables us to analyse arguments more clearly. When assessing an entitlement, we can weigh the benefit claimed against the obligation imposed on others to provide it. We should also be alert when an attempt is made to distort a freedom into an entitlement. Freedom of speech or freedom of expression should not give rise to an entitlement to pornography whilst in prison.