Published: 14/10/2004, Volume II4, No. 5927 Page 16 17

Choice, a central role for public health, and GPs being given control of their own budgets are all familiar strands of Labour health policy. But last week it was the Conservatives who were kicking these ideas around the ideological park as the party gathered in Bournemouth for its last conference before the general election. Shadow health secretary Andrew Lansley went all out to impress on delegates that the Tory path was not only different - but better. Helen Mooney listened in

Choice: empowered patients, disempowered bureaucrats

What's the difference between Labour and Conservative policy on health? More importantly, what makes the Conservatives' policy superior? That is the question shadow health secretary Andrew Lansley was trying to answer in Bournemouth last week.

But some of the subtleties do not make for easy tabloid headlines. For both parties, choice is key to their proposed reforms. As Mr Lansley said, 'the right to choose is central to reform'.

'Choice is a powerful means to an end - to deliver the services patients need.'

The difference, he argued, 'between the government's policy and that of the opposition', is that 'ours is a practical choice'. Patients would be armed with information, empowered to take decisions.

Improving the lot of people with long-term conditions is also key.

But at the Labour Party conference a week earlier, delegates had also heard of the importance of information in enforcing the choice agenda.

OK then, the real difference, as Mr Lansley explained, came down to the limits that a Labour government would impose on choice - and the role of NHS bureaucracy in enforcing them.

'A reformed NHS is one that is accountable to patients, not to bureaucrats... Labour would restrict choice to the options decided by the bureaucracy. That is no choice.'

Bureaucracy and bureaucrats were two regular targets in his keynote speech. In the verbless half sentences now adopted by politicians of all colour, he promised that under a Conservative government, extra money for the NHS would not be wasted.

'So that funds get to the frontline. That the service is not submerged in bureaucracy. That we recruit doctors and nurses three times faster than managers, not the other way round. Where hospitals do not have 41 different inspectors or 250 different targets.'

Mr Lansley insisted that a Conservative government would translate its words into action within hours of achieving power.

'On the first day, we will abolish central targets imposed on hospitals so doctors, nurses and managers will be able to run hospitals in the interests of patients.'

In the first week, the government would prepare for the introduction of the right to choose policy. Given that the Conservatives are promising total choice for all patients by the end of 2005, they will need to prepare fast.

Within a month, said Mr Lansley, a Conservative administration would introduce legislation to free the NHS from Whitehall controls, making every trust a foundation trust, provide a new framework for mental health services and establish a strategy on public health.

Public health: 'Labour's mixed messages have caused crisis'

Public health will be central to a Conservative health strategy, so much so that the health secretary would be renamed secretary of state for public health.

In their first month in government, the Conservative Party would introduce an action plan to address the health of the nation.

According to Mr Lansley, a major role for government would be to co-ordinate public health at a national level.

He told the conference that public health would become his 'personal priority'.

He pledged to establish a public health commission and local public health teams, which would 'ensure co-ordinated, consistent efforts, across private and public sectors, to tackle the problems of poor sexual health, alcohol and drug abuse, smoking, poor housing and poverty'.

Mr Lansley has promised that he will bring together primary care trust public health functions, the infections role of the Food Standards Agency and local authority public health work under a single public health director.

The National Institute for Clinical Excellence would also take a stronger public health remit.

He accused the government of allowing public health to become 'fragmented' and said that 'confused and mixed messages from Labour ministers have resulted in a crisis'.

In a later fringe meeting, he told delegates that unless the government dealt with smoking, obesity and the rising number of tuberculosis, hepatitis C and HIV cases today, 'the NHS will have to live with substantial additional demands on services in future'.

GP fundholding: blast from the past set to make a big return

A Conservative government would bring back GP fundholding and expand it to all GP practices, junior health minister Tim Loughton told delegates at a Conservative Medical Society fringe meeting.

He said that in order to have a system that gave patients '100 per cent choice', funding needed to follow the patient, and this would mean that GPs were able to control their own budgets directly.

Mr Loughton said that he wanted to see 'GPs freed up to provide a range of specialist services, like in GP fundholding days'.

'It is crazy that we have a secretary of state who still micro-manages from a desk in Richmond House, ' he said.

He added that GPs would be free to refer patients to any organisation that could treat them whether it was NHS or privately run.

Conservative health policy would also open up the NHS market to the private sector. Mr Loughton claimed that 'any hospital that can meet tariff price will be entitled to provide services to NHS patients'. He questioned why NHS hospitals should have a monopoly on this.

The policy hinges on opening up the market more extensively in a bid to drive down waiting times because patients will choose to go to a much wider variety of hospitals from a much larger group of providers.

The Conservatives' pledge

1 Cut waiting lists

2 Invest more in the front line

3 Give patients greater choice

4 Clean dirty wards

5 Give doctors and nurses control

Conservative timetable for Action on Health

Day one

Abolish central targets on hospitals so doctors, nurses and managers run hospital in the interest of patients.

Week one

Prepare for a right to choose, including providing access to information on performance and infection rates in hospitals.

Month one

Introduce legislation to free the NHS from Whitehall controls and establish a Health of the Nation strategy.

Bournemouth in brief

Shadow health secretary Andrew Lansley attacked the government's failure to tackle the problems of NHS dentistry and promised a policy that would see dentists paid for the number of patients on their books rather than billing for each treatment.Patients could also choose to pay a monthly fee in order to avoid one-off large payments.Mr Lansley pledged to 'give patients the means and dentists the incentives to put NHS dentistry back on the high street'.

Addressing a Royal College of Nursing fringe meeting, Mr Lansley said Tory health policy would help patients with long-term conditions have a greater say in the management of their illness.He said the plan included the National Institute for Clinical Excellence 'leading on chronic-disease management in the community'.

Both Mr Lansley and junior health spokesman Tim Loughton told delegates that the increase in cases of MRSA (methicillin-resistant Staphylococcus aureus ) was the fault of hospital managers and waiting-list targets.He said nurses were 'being put in the unhappy position of requesting wards be closed because of lack of cleanliness, but chief executive or management say that wards can't be closed because of waiting list targets'.

Mr Loughton promised that a Conservative government would put an immediate end to the sale of NHS land to private business.He said the government had taken the decision to sell off 140 NHS sites to private consortia to raise capital but had then decided to hand them over to the Office of the Deputy Prime Minister to sell.Mr Loughton claimed that under a Conservative government the land would be used to build affordable housing.

Community health councils should not have been abolished, Mr Loughton said at a fringe meeting on patient choice.'The trouble is, he said, 'we have abolished CHCs when they in fact needed to be beefed up; their role is as the patient's friend'.Mr Loughton said that this advocacy function was crucial if patient choice was to be effective.

The Conservatives would not ban smoking in public places if they formed the next government, Mr Lansley told an RCN fringe meeting.He added: 'I do not believe that we [politicians] and industry have really tried. I am not persuaded that the time has arrived for legislation.We want education before legislation.'