Competition, choice and clinician power: the shadow health secretary lists the ingredients that he would use to make NHS outcomes the best in the world

This summer’s debate surrounding President Obama’s health plan has brought home to observers on both sides of the Atlantic just how much people care about their health services.

Patients will be armed with choice of a GP and hospital, and meaningful information about the results different providers achieve, so they are empowered to demand the highest standards

Across the US, ordinary citizens turned up in force at town halls to voice their hopes and fears for healthcare reform, because few things are more important to people than their health and the health of their families.

That’s why we’re so fortunate in this country to have the NHS: a service that’s there for everyone free of charge whenever they need it. The Conservative Party backs the NHS completely, and we’ve made clear that it’s our number one priority. But we know the NHS is facing a daunting future. Against a backdrop of declining productivity, rising expectations and costly advances in treatment, the NHS must meet the needs of a rising and ageing population at a time of crisis in our public finances.

The Conservative Party has pledged real terms increases in NHS spending to help our health services rise to these challenges. But if Labour’s stewardship of the NHS has taught us anything, it’s that spending more money alone will not guarantee improvements.

While taxpayers have seen their input treble, patients have not seen a commensurate return in the results of their treatment. We spend around the European average on our healthcare, but British patients’ survival rates lag behind European averages on the majority of measures.

David Cameron and I are determined to turn this situation around. Real support for the NHS means a real commitment to the reform it needs to deliver world class healthcare in a cold economic climate. Over the last decade, the increase in public resources has been greater in the NHS than anywhere else. So in the NHS, the responsibility to use those resources well is heavier than anywhere else. Our real terms guarantee will be accompanied by a reform programme which creates real incentives to increase outputs and reduce input costs.

First, we will free clinicians from a top-down structure of process targets, so they have the autonomy to respond directly and flexibly to patients’ requirements. As those in the closest regular contact with patients, we believe GPs are well placed to commission the best quality services for their patients. We will hand them real budgets to manage the costs of their patients’ care. And we will require accountability at all levels for results, measured in terms of patient outcomes, rather than narrow distorting targets.

With part of GPs’ pay dependent upon the results of their patients’ treatment, they will have a direct incentive to buy the most efficient services on behalf of their patients, because they will be able to keep any savings and use them to reinvest in care. Primary care led commissioning will provide the essential combination of clinical decision making alongside accountability for resources.

Patients, in turn, will be armed with choice of a GP and hospital, and meaningful information about the results different providers achieve, so they are empowered to demand the highest standards.

Second, we will drive efficiency by opening up the NHS to allow any provider to compete to offer NHS services if they meet the necessary high quality standards. By increasing the number of organisations aiming to provide care for patients, we can drive down costs and ensure NHS care is provided by only the most efficient and effective organisations. We will also move to a payment by results tariff where no hospital can expect to be paid more for treatment than the benchmarked cost in efficient providers, creating powerful incentives to save money.

Third, we will tackle the real drivers of demand on the NHS. It is a frustrating fact of life for many staff that while they deliver first class medicine, their efforts are hampered by the impact on their patients of poor diet, lack of exercise, alcohol and drug use. We will give a new priority to public health reform, with separate funding, a stronger local infrastructure and a focus on national strategies to unleash individual, family and community responsibility.

Time and again over the last 12 years we have seen headline grabbing announcements about new initiatives. But the truth is that patients have yet to see the real benefits on the front line. We are determined that the savings we make will be ploughed straight back into frontline care. By trusting professionals, empowering patients and putting competition and choice at the heart of the NHS, we will deliver the quality and productivity gains needed to reduce costs and improve outputs for patients. My ambition is for the NHS to have health outcomes at least as good as any in the world; to combine equity with excellence.