With the polls tipping in their favour, the Lib Dems are under increasing pressure to spell out what they would do in the case of a hung parliament, or if they were to win outright. The shadow health spokesman says axing SHAs, devolving power to local bodies and focusing on prevention would be among his first moves

Ensuring that the NHS continues to thrive is one of the greatest challenges facing the next government. Whoever wins the election will have to face up to the fact that the scale of the public deficit and the state of our economy means the era of ever expanding budgets has come to an end. Those of us who care passionately about the NHS must ask new questions: not just “how much” but “how” we spend money. I believe we can protect and improve the NHS in an age of austerity, but to do that requires a new approach.

Strategic health authorities often act as nothing more than outposts of the Department of Health, there to enforce the secretary of state’s will on the local NHS

Many of you will have seen a dramatic shift in the polls in recent weeks. None of us can predict how long this will last. But I think the electorate’s willingness to consider the Liberal Democrats is due in part to the failure of Labour and the Conservatives to articulate a convincing vision for the country. Both of the old parties insist they are the only ones who can be trusted with the NHS, but such protestations fail to mask their lack of vision for the future.

Lib Dem alternative

The Liberal Democrats offer a real alternative. Our vision for a liberal NHS has flexibility, accountability and fairness at its centre. Instead of dictating from Whitehall, we will give local people the power to set priorities through elected health boards. Instead of second guessing managers and staff, we will give them the freedom to innovate and develop services. And instead of constantly setting targets and demanding endless reports on how they are being reached, we will trust clinicians to know what’s best for their patients.

Constrained public finances mean that difficult decisions must be made. Labour’s approach has been to demand “efficiency savings” while refusing to spell out what that actually means. By cutting indiscriminately now, we are storing up trouble further down the line. The Conservatives’ decision to ringfence the health budget has more to do with their own party interest than what’s best for the country. Their approach will mean wielding a knife violently across all other public services. This is not something we are prepared to do.

The Liberal Democrats are taking a different approach. No budget will be ringfenced, including the health service. We will look for waste and unnecessary programmes of spending wherever they lie. Where we identify savings in the NHS, that money will be reinvested in services that have been starved of cash or could be in future years. Only the Liberal Democrats are determined to be bold about reforming the NHS.

The big question, of course, is how to deliver that reform. In my view, there is a basic problem with the NHS that needs to be addressed. It is over-centralised and still driven far too heavily by targets and bureaucracy. Central directions, onerous inspections, waste and a micromanagement - these are the hallmarks of the old approach to government. By refusing to tackle the inherent problems of a centralised system, Labour and the Conservatives will never deliver greater efficiency in the NHS.

End of SHAs

We want to radically change the way the NHS is run by devolving power to local people. This will release money to be spent where it matters on patient care. In a decentralised model, the need for a costly, all-powerful Department of Health, micromanaging the day-to-day operation of the NHS, disappears. So we would start by cutting back on the central department.

Similarly, we need an administrative and regulatory system which supports rather than smothers the NHS. Strategic health authorities often act as nothing more than outposts of the Department of Health, there to enforce the secretary of state’s will on the local NHS. We will abolish them and devolve their budgets to local health boards.

In the same vein we know that some quangos carry out vital work. But we also know that there is duplication and waste that can be reduced. It’s crazy that there are a plethora of organisations responsible for patient safety - we will make one body responsible for making patients safe. We will also carefully trim back the budgets of others.

Focus on prevention

If we are to build an NHS that can respond to the emerging health challenges and work within the pressures of tightly constrained public finances, then we are going to have to focus on prevention and early detection to a much greater degree. We will reform the quality and outcomes framework and payment by results system to encourage long-term doctor patient relationships and preventative care.

We believe patients have a right to quick treatment which is why we set out an entitlement to private sector treatment if the NHS fails to deliver on time. I was of course delighted when Labour hastily adopted our long-standing policy just months out from the election.

Under the Liberal Democrats, the NHS would be better placed to respond to local circumstances. Part of this must be better integration between health and social care. In areas where this has happened the results are encouraging and it is an example of where local cooperation is the way forward. As we move towards delivering more care at home, I believe the case for integration is hard to argue with.

It’s clear that people want change at this election but have little appetite for a continuation of the old red and blue politics. Liberal Democrats have a vision for the future of Britain’s health service. We want a people’s health service where communities, not government, are in the driving seat. We want to empower patients to take control of their own care wherever possible. And we want to guarantee fast and efficient treatment through clear individual entitlements.

These are the priorities of the Liberal Democrats and together we can make it happen.

Elected PCT boards - we're not ready