The Tory 'Stop Brown's NHS Cuts' campaign

Six questions for David Cameron and the Conservatives

1. How can the Conservatives credibly campaign against NHS cuts when they voted against increasing investment in the NHS to its current level?

2. How can Cameron be trusted when he has watered down his commitment to the NHS already?

3. Will Cameron be able to resist the pressure from his party for swingeing cuts in health and other public services to fund tax cuts?

4. What say will there be for patients in their plans for an independent NHS?

5. How much further would the Tories take the privatisation of the NHS?

6. Can we trust someone who, just last year, was campaigning to divert money out of the NHS to subsidise private health care?

Liberal Democrat Shadow Health Secretary Steve Webb

"The electorate will not be conned by the Conservatives when it comes to the NHS.

"They will remember the years of under-funding and neglect when the Tories ran the health service. They will remember that the Tories voted against a big cash boost for the NHS in the last Parliament. And most of all, they will understand that the Tory instinct - as shown in the manifesto that David Cameron himself wrote - is to subsidise the few to opt out of public services, instead of improving them for the many.

"The label on the tin may have changed, but Tory instincts have not. The NHS is certainly in trouble, but the Tories are certainly not the answer."

The Conservative campaign (background)

The Conservatives have launched a campaign to "Stop Brown's NHS Cuts" (see http://www.conservatives.com/tile.do?def=campaigns.display.page&obj_id=132788).

Their campaign is calling for:

1. An end to short term policies - of cutbacks and closures and of not putting enough into public health

2. No more Government interference in the NHS by

a. Setting up an independent statutory regulatory framework to oversee the management of the NHS

b. Establishing an independent, statutory body to ensure the views of patients and members of the public are represented in changes to the local NHS

3. Redirecting NHS funding

a. So that it accurately reflects the burden of disease in areas

b. So that most NHS funding is provided directly to GPs to spend in the best interests of their patients. They want to take the power to determine the demand for local NHS services from managers in PCTs and place it hands of GPs.

4. Choice - they support GPs being able to refer their patients to any healthcare provider which would serve their patients best interests.

Response

The Tory Record

Remember the Tory neglect of the NHS in Government: starving it of investment and creating long waiting lists.

Key fact: Figures obtained by the Liberal Democrats from the House of Commons Library show that in their last year in office the Tories actually cut real spending on the NHS (annual % increase in real terms 1996/7: -0.2%). Also:

- Under the Tories people waited over two years for an operation .

- The average daily number of NHS available hospital beds fell from 364 in 1979 to 194 in 1997/8

- The Conservatives presided over payment negotiations which saw many dentists reduce their NHS work. John Renshaw, Chairman of the Executive Board of the BDA [British Dental Association] said that the 1992 fee cut is still seen as a "scar running through the profession that has never been put right".

- There were more than a million people on NHS waiting lists under the Tories .

- Britain spent an average of 5.5% of GDP on health expenditure in 1996/7, this was well below the European average .

- Despite their rhetoric on tackling hospital superbugs, the Conservatives forced hospitals to contract out their cleaning - price was more important than quality. The result: standards fell and responsibility for ward cleaning fragmented. Under the Conservatives the true level of hospital infections was unknown because they did not bother to collect the information.

- The number of nurse training places fell from 16,338 in 1992/3 to 14,984 in 1996/7

- Eye tests were free in 1979 but in 1997 they cost an average of £16-£17 .

- Over 50,000 operations were cancelled in 1996/7

Questions for the Tories

The Conservatives have some important questions to answer -

1. Investment

How can the Conservatives credibly campaign against NHS cuts when they voted against increasing investment in the NHS to its current level?

- During the last Parliament Gordon Brown increased the rate of National Insurance Contributions on both employees and employers specifically to put extra money into the NHS. Labour and Liberal Democrat MPs supported the move, but the Tories voted against. If they had had their way, the NHS would have been deprived of around £8 billion per year - or roughly ten per cent of its entire budget.

On the eve of Brown's budget speech announcing this extra money in April 2002, the Conservative leader, Iain Duncan Smith, produced a report supporting a healthcare system funded through social insurance - where employer and employee pay towards a compulsory health insurance plan - rather than a system funded through general taxation .

How can Cameron be trusted when he has watered down his commitment to the NHS already?

- David Cameron dropped a point in his speech to Tory conference, which promised that he would not cut funding in the NHS . So despite his supposed commitment to the NHS, he is saying that he may spend less than the current Government on the deficit-ridden health service.

"We will never jeopardise the NHS by cutting its funding."

Line in text of Cameron's 2006 conference speech released to the media

"We will always support the NHS with the funding it needs."

What Cameron actually said - avoiding saying the Conservatives would never cut NHS funding

Will Cameron be able to resist the pressure from his party for swingeing cuts in health and other public services to fund tax cuts?

- Cameron's own tax commission has reportedly come up with a package to cut almost £20 billion in taxes - money which would have to come from public service finance . The Conservative party's statement of values, published in March 2006, claims that a Tory government would share the proceeds of growth between tax cuts and public services .

2. Accountability

What say will there be for patients in their plans for an independent NHS?

- In their plans, bodies to represent the views of patients and the public are separate to the independent management body and to the overall planning power of GPs. By itself, devolving power to the professionals does not mean that local communities and ultimately patients will have more control over the services on which they depend.

- Giving GPs power to commission services is something already being done by the Government in the form of Practise Based Commissioning. The scheme is currently beset by problems. An Audit Commission report in June 2006 said the Government's flagship scheme risks "exacerbating financial pressures", "widening inequalities" and wasting money. GPs at the annual LMC conference in June 2006 claimed that the scheme could shift blame for NHS inadequacies from PCTs to GPs and offloads historic deficits onto general practice. How will the Tories address these problems if they are planning on increasing GPs freedoms - and what form will this take? How will they ensure that doctors are accountable to patients, rather than to themselves, and we do not have a repeat of the wasted opportunity of GP contracts?

The real challenge is to create local accountability in the NHS - so that people have a genuine say in the running of their local health service. Cameron's plans do nothing to address this.

Without making the link between what patients want and the shape of the health service, any independence will create another layer of unelected bureaucracy - independent of politicians, but accountable to no-one.

3. Role of the private sector

How much further would the Tories take the privatisation of the NHS?

The Conservatives' record shows that they instinctively favour private provision - and have been in favour of creating a two-tier health service, where the richer can opt out of the NHS. With their newly announced plans for unlimited private sector involvement in the NHS, the health service could end up being run on a 'for profit' basis.

- Health spokesman Andrew Lansley said in the Financial Times, 9th October 2006, that the independent sector - both private and voluntary - would have the right to bid for NHS work; and that patients would be able to choose treatment at all hospitals. That would mean "no artificial limits" to the size of the private sector in the NHS.

- In an interview with the Sunday Times on 1st October 2006, Tory policy chief Oliver Letwin said there would be no limits to private sector involvement in the NHS.

Can we trust someone who, just last year, was campaigning to divert money out of the NHS to subsidise private health care?

- Only last year, David Cameron himself wrote a Tory manifesto that proposed a 'patient passport' scheme, where people who could afford to pay for half of their treatment would have the rest paid for by the Government, allowing them to opt out of the NHS. This would have meant even less money to spend on healthcare for the majority of people who cannot afford to opt out. It would have taken £1.2bn of NHS money without providing a single extra operation.

Pro-market think tank Reform, has said the policy would end patients' rights to NHS treatment, providing choice only for those able to pay more:

"The "Patients Passport" does not refocus the NHS around the needs of the patient. It does not provide a right to treatment. Primary Care Trusts will decide whether patients are able to access hospital treatment and if so which kind, depending on their budgets as well as patients' clinical need. If patients wish to be treated in the private sector, they will be able to take only 60 per cent of the cost of an NHS operation with them. That element of the policy therefore provides choice only for those able to pay the extra cost."

Earlier this year (4th Jan 2006) Cameron said in a speech that the patient passport was being dropped. But what does it say about his and his party's judgment that something so damaging to the NHS was the centrepiece of their health campaigning only last year? Is this a whole-hearted change of policy or just what the spin doctor ordered?