thetorydiary

Some of press are crying "new Tory NHS row" this morning after a Conservative politician with a background in medicine spoke out in favour of charges for people to see their GP - and fines if they fail to attend appointments.

The politician in question is Dr Charles Tannock, a former consultant psychiatrist, who has been a London MEP since 1999 and is a regular contributor to the CentreRight blog on this site.

He told Channel 4 News:

"I would be totally in favour of small co-payments, small payments being made if you turn up to things and perhaps small fines being levied if you do not. I know they are controversial but I don't think people who are in a job would be against say spending £10 to see their GP or being fined £10 if they don't show up to an out-patients, so that's the sort of thing I would like to see."

Dr Tannock also backed a pay freeze for doctors:

"Right now the doctors in the NHS are the most highly paid doctors in the public health services in the whole of Europe, possibly the world, so maybe we may have to have a freeze on doctors' pay in the future."

Andrew Lansley, the shadow health secretary, quickly moved to reject the idea of co-payments as mooted by Dr Tannock - as we reported was the position last month:

"Charles may say 'oh well £10 to see a GP' - well that would not make any difference to hospital care and frankly, if you tried to put in such a system, by the time you have done all the bureaucracy of raising the money and levying some fines, you would not be raising any money for the NHS anyway."

11am update: Dr Tannock has commented on the thread below to further explain his position in the light of a 15 minute interview being cut into a short soundbite out of context:

Yesterday evening I set out the five reasons why David Cameron can win the NHS debate for the Conservatives.  But that's entirely a political victory.  The Tory leadership has offered every support to the professionals within the NHS and is willing to cut deeply into other public sector budgets in order to achieve this victory.  If the Conservatives couldn't at least neutralise the NHS issue on the back of this breaking-the-bank spending (opposed by 63% of Tory members) then it would be a pretty poor performance.

Speaking in Bolton later today David Cameron will say "We've earned the right to call ourselves the party of the NHS."  "Earned" may not be quite the right word.  The fiscal implications of the Tories' NHS spending pledge are enormous.  Mr Cameron will use his Bolton speech to explain why increases in NHS spending are justified:

"The debt crisis means we need a new approach to public spending, to make sure we get more for less.  But in the NHS, even that won’t do.  The pressures on healthcare spending – from an ageing population, from medical advances, and from rising expectations – are simply too great... Spending on the NHS cannot stand still, because standing still would be taking a step backwards.  That is why we have pledged real-terms increases in NHS spending - unlike Labour – a fact which, to put it mildly, takes the wind out of their point-scoring sails."

I Tweeted this last Friday...

...and I kind of feel my source has proved their value with the news that Cameron is going to give a big speech on the NHS tomorrow.

I don't think Cameron needs to be afraid of the NHS debate for five main reasons:

• Labour's record on the NHS is very uneven.  The targets, poor cancer survival rates, the deprofessionalisation, the collapse of NHS dentistry, MRSA and Labour hypocrisy would be at the top of my list.
• Cameron has a very powerful and personal commitment to it because of the care it gave his son Ivan.
• Shadow Health Secretary Andrew Lansley is hugely respected by NHS professionals.
• The Conservatives intend to spend tens of billions more on the NHS - beating inflation.  I'd prefer that we were more modest in our commitment to the NHS budget but if you're going to break the bank on the NHS you might as well get the political reward.
• A sensible (if cautious) set of NHS reforms (particularly on improving preventative public health) that will deliver better patient care.

There'll be full coverage of the speech on ConHome tomorrow.

Tim Montgomerie

Yesterday John Prescott attacked Dan Hannan for criticising Britain's NHS during a visit to the USA.

Paul Waugh has just blogged the Shadow Health Secretary's put down of Mr Hannan:

"There are millions of people who are grateful for the care they have received from the NHS.  It does them and the NHS a disservice for Daniel Hannan to give Americans such a negative and partial view. That we can access healthcare free at point of use, based on need, is something others envy. Our task is to ensure that the quality of care is consistently excellent. And the service is efficient and responsive to patients. Choice, competition and information, focused on outcomes, will deliver this."

Quite unnecessary from Mr Lansley in my opinion.

Dan broke away from his holiday yesterday to explain himself.  Read it here.

The best thing said so far on all this is CentreRight's very own Graeme Archer.  This is what he wrote earlier:

"My experience of the NHS suggests the following. That when it works, as it usually does, it is, without doubt, the envy of the world. But what happens when it doesn't work so well? Keith has a big scar on his left leg, the result of being knocked off a motorbike by an ambulance (I know, the irony - it didn't even take him to hospital) (I'll be in trouble if he reads this too). The particular hospital ward he ended up in for two weeks was badly managed, dirty, and full of evidence of patients left unattended and in distress for too long every day. This is not typical, but it is a fact, as was the powerlessness of the patients in that ward, or their families, to enact any change.  Should I wipe my memory clean, and replace it with a #welovethenhs 140-character paean of praise? Was that which I saw to occur, to real human beings, some sort of false consciousness? Have I committed a political crime, by writing this down? Am I forbidden to share our experience of that NHS ward, because to do so is automatically a 'gaffe'? If #welovethenhs is the end of the debate, what, really, is the point of politics?"

Tim Montgomerie

10pm: David Cameron has blogged in defence of the NHS

There is more today on the story which first emerged at the beginning of July about Conservative plans to allow patients to transfer their medical records to private companies which would put them online.

The Independent on Sunday reports that not only would patients be able to access their own records online, but that they could also:

• amend certain information;
• leave comments on symptoms, medication and treatment;
• share the data with gyms, private clinics or weight loss groups;
• join online "communities" of people with the same condition or illness to swap experiences and receive support.

Shadow Health minister Stephen O'Brien told the paper:

"Giving patients greater control over their health records is crucial if we are to make the NHS more patient-centred. Labour's attitude to personal data is misguided. They seem to think they own it and, all too often, they have been appallingly careless in looking after it.

"The Government's monolithic and costly IT system doesn't involve patients at all. Yet in patients' hands, health records could do so much more. We would have a clearer picture of our health and our care and we would be able to add information to help doctors treat us better. This could make a huge difference in helping us understand how to live healthier lifestyles."

The proposals have been given a thumbs-up by Steve Field, the chairman of the Royal College of GPs:

"We 100 per cent support the principle of putting patients in more control of their health as long as the IT system used is flexible, safe, and cost-effective, and moves us more quickly towards e-health and e-consultations. There must be safeguards, however, to ensure vulnerable patients don't come under pressure to release information to external agencies and also to ensure that information added by doctors cannot be deleted or edited without discussion. Apart from that, we support anything which helps patients take more control of their own health."

10am update:

Speaking on the Andrew Marr Show, shadow health secretary Andrew Lansley said that tomorrow he will be publishing an independent review on health policy which he and Stephen O'Brien commissioned, which will include the proposals for greater personal control of health records.

He said the the Conservatives would focus on "moving away from this top down centralised single NHS system into one which is decentralised, which is led by users..." whereas the Government's attitude on data had been that is it all owned by government.

He repeated that Conservatives would match government spending this year and next year - but pointed out that beyond 2011 it is not known what Labour's plans are - saying that the Conservatives' "priority is for the NHS not to be cut back".

Whilst wanting to make savings by getting "more for less from existing resources", he said that a Conservative Government would use money to pay for improvements, additional health gain and for responding to an ageing population.

"We have pledged to real terms increases for the NHS year on year," he reiterated.

Jonathan Isaby

Labour have been claiming for some time  that the debate over the NHS is one of "Tory cuts" v "Labour investment".

Yet the lie of this claim is again nailed today in a piece which John Redwood has written in today's Yorkshire Post:

"The Government often implies no cuts of any kind are possible without damaging front line services. So who said the NHS should face value for money savings of £8.2bn by 2010-11 compared to 2007-8? No, not David Cameron, but the Government.

"While implying in the political debate that the NHS is fully efficient, the Ministry is busy telling the NHS to become more efficient at the rate of 3.5 per cent a year in 2010-11, after demanding a 3 per cent improvement this year."

Whist accepting that both parties are committed to avoiding cuts in front line services, Mr Redwood summarises the big difference between the parties thus:

"The Conservatives want to delegate more power and authority from the centre and the quangos, to the wards and surgeries themselves. Labour believe in the efficacy of many national interventions, endless orders and requirements from a large number of national quangos, with regional authorities offering direction and budget control.

"The real row over health spending is not Tory cuts versus Labour investment as the Government wants you to believe. It is between Conservative claims of devolved efficiency and Labour's centralised waste."

Jonathan Isaby

The Conservative Party's health spokesman Stephen O'Brien MP has just released an analysis of the wide variation in service provided by Primary Care Trust when it comes to the number of antiviral collection points:

• There is no evidence of antiviral collection points at all in eight Primary Care Trusts.
• 47 Primary Care Trusts have just one collection point, whereas ten have more than 30.
• There is no clear link between the number of cases of swine flu in an area and the number of collection points – for example, in London, which has been a hotspot, ten Primary Care Trusts have just one collection point.
• There is also no clear link between the rurality of an area and the number of collection points – East and North Hertfordshire and West Hertfordshire Primary Care Trusts each have just one collection point, for example.

Last week I wrote this:

"Co-payments were a big idea of David Cameron's Tory leadership bid but little has been heard about them since.  Then he talked about students helping to pay for their university education and motorists helping to pay for roads.  Will charges for certain medical services be one way of a Tory government maintaining NHS spending without plundering other departmental budgets?  I'm only speculating."

For the record I've now been told by an impeccable Tory source that co-payments have been ruled out for the NHS and that it will remain free at the point of use.

That makes it all the more important that the party narrows its commitment on NHS spending.  Earlier I suggested that it move to a position of protecting frontline services only.  Andrew Haldenby of the Reform think tank left a comment saying I was being too cautious.  His view is worth highlighting:

"Tim, please forgive me if I disagree with you. (Although I agree completely about the unsoundness of the Conservative spending pledge). The problem is that the mis-use of the NHS budget lies in the front line. The NHS will become much more efficient only when its doctors and nurses are employed in different ways and its buildings are used in different ways. The “front line” of any more efficient system is going to look very different. A pledge to protect the “front line” will just compound the problem. A fuller case is set out in a previous Telegraph column here and our Budget paper here. This is the task of political leadership – to explain that the NHS has to change. Your idea would fail that test."

Tim Montgomerie