NHS (60th Anniversary)

That suggests to me that waiting time targets might re-emerge, either locally or through the independent board. [Interruption.] Well, if the Conservatives' conclusion is that they will not have either national or local targets or entitlements, I think there is a severe flaw in their overall package. We must never take access for granted. To focus on outcomes almost assumes that access is a given, but we can never assume that that is the case. Just as we have managed to improve waiting times, they can easily slip—and we must remember those areas such as mental health where waiting times are horrendous. To abandon targets, and to have no access incentives and no entitlements for patients, will have potentially disastrous consequences. I also think it will run the real risk of worsening health inequalities. Our approach focuses on entitlements for patients and recognises entitlements to access treatment. It recognises that many people, who might not be articulate and understand how to play the system, will need help in exercising their choice and in making the right informed judgment. That is why we think that a network of patient advocates can help people in making the right decisions about their own health care. Let me now turn to what I think the priorities should be for the future of the health service, and to what the Liberal Democrats' approach would be. Let me deal with the question of pruning back the role of the central state. I have made the case against the Government's approach, which stands alone, if one makes international comparisons, in the extent to which it seeks to control the delivery of health care from Government offices in the centre. It seems to me that the Government should focus on key functions such as, first, the fair distribution of resources around the country, so as to ensure—without political interference, incidentally—that the resources get to where the need is greatest. Secondly, it is right nationally to focus on high professional standards within the NHS. Yes, the Conservatives are right to focus on setting a framework for the delivery of improved outcomes, but it is also right to focus on the right to access to health care wherever people live in the country, and irrespective of their means. So yes, our approach is to recognise that access is important and to introduce the idea of an entitlement to access treatment within a defined period. The system in Denmark works well there. The idea is that people get access to condition-specific treatment within a defined period, and if they do not receive the treatment, it is paid for by the locally elected health board, if necessary in the private sector. Interestingly, it has not led in Denmark to a haemorrhaging of patients to the private sector; rather, it has been the biggest single driver of improved efficiencies within the state hospital system. [Interruption.] It is absolutely not the patient passport, and the hon. Member is either being disingenuous or not understanding. The patient passport was a subsidy for people who could afford to top up the rest of their care for private treatment in the private sector. This system pays for a person's operation in its entirety. Crucially, in mental health, the person who has no resources to go to the private sector to circumvent the one-year wait for cognitive behavioural therapy would also be entitled to their treatment within that defined period, and if they did not get it, it would be paid for privately. That is giving real power to individuals, irrespective of their needs. We also believe that we should be empowering local communities, democratising primary care trusts and imposing on all PCTs—locally elected health boards, as we would call them—a duty to ensure the efficient use of resources. The health think-tank Reform has talked about an economic constitution for the NHS. That is the right approach, ensuring that money is used most effectively. Compare that approach—empowering communities—with that of the Conservatives. At the moment, one person is democratically elected within the health service: the Secretary of State. The Conservatives would lose that one person and have an independent board that was not democratically accountable in any shape or form. Just imagine: when a local community faced the loss of their hospital, they would have no right to decide locally whether that hospital would close. Decisions would be made by unaccountable, unelected bodies nationally. At that stage, in my view, the wheels would come off. The Secretary of State recognises that there is a democratic deficit within the health service but he appears unwilling to do anything about it. The Minister may well want to address that issue when he winds up the debate. We recognise that there must be democratic accountability within the health service. The Government recognise that there is a problem; what are they prepared to do about it? Thirdly, we want to empower patients far more than they are at the moment. No longer can we accept the idea of care delivered from on high to grateful, passive recipients. People want to take charge of their care and they need, as the Conservative spokesman said, access to information so that they can make the right choices; but as I have said, they also need access to support in guiding them in making the right decision. We also support the idea of individual budgets being piloted in the NHS and of seeking to give people more control in coping with long-term chronic conditions and so on. Our fourth principle is fairness, equity and addressing those health inequalities that scar our society. One of the issues that must be addressed is the fact that there is less access to primary care in poorer areas than in wealthier suburbs. The mechanism that the Government use is the central imposition of GP-led health centres, and they are also promising to bring more GP practices to impoverished areas, but surely the financial incentives to undertake primary care must also be addressed. At the moment, a GP receives more money if they practise in a wealthier area than they do if they practise in a poorer area. There should be financial incentives to encourage GPs to practise in those more challenging areas. We are developing the idea of a patient premium, whereby extra funding is attached to patients from deprived backgrounds to encourage GPs to provide support for those communities. As the NHS reaches its 60th birthday, it is time for an injection of Liberal thinking, as there was at its very beginning. The NHS can adapt, evolve and prosper. I am passionate about giving power to those people who have no power in our system. That is as important a principle in health care as it is in any other walk of life. Communities, not Government, should be in the driving seat in shaping the delivery of local health services; patients should take control. Fast, efficient, high quality care should be guaranteed to patients, putting individuals before institutions. That is how we should build on the past successes of the NHS as we look ahead to the next 60 years.