Nick Clegg calls for a People's Health Service (part 1)

10 June 2008

Speaking ahead of the 60th anniversary of the founding of the NHS, Liberal Democrat leader, Nick Clegg, addresses the health think-tank The King’s Fund. He criticises the Government’s record of waste and inefficient centralised control in the health service, which has led to widening health inequalities.

Nick Clegg sets out the Liberal Democrats' plan for a People’s Health Service, which prunes back the role of the state in the NHS, devolves power to local communities and empowers individual patients.

Read part one of Nick Clegg's speech below. You can listen to extracts from the speech by clicking here.

Introduction - the strengths and weaknesses of the NHS

Thank you for being here. And thanks also to the King’s Fund. Your analysis, ideas and research do much to stimulate debate about the future of health services in Britain. And as the NHS celebrates its sixtieth birthday next month, the state of those services will be as hotly debated as ever.

After all, there is no other institution that commands the degree of public pride and respect as the National Health Service.

Established with the noblest of intentions, and owned by the British people themselves, it is understandable and right that the NHS enjoys such affection. Throughout the past six decades NHS services have benefited each and every British citizen. And they continue to do so.

The advancing frontiers of knowledge, science and technology have led to extraordinary medical breakthroughs in the relatively short post-war era.

From the vastly improved survival rates for premature births, through cures for multiple strains of cancer, to drugs slowing down the onset of Parkinson’s Disease - our NHS has pioneered Britain’s assault on ill health. And we are right to celebrate it.

Ironically, the British media tends both to stoke this sense of pride while simultaneously talking up the apparent failures in the health care system itself. Pride and cynicism - a confusing message.

But it is fair and right to highlight genuine shortcomings in any institution. And the NHS is no exception

If we don’t do that, we succeed only in limiting our capacity for improving the services that it provides. Honesty is most definitely the best policy.

The Failure of Labour and the Conservatives to Grasp the Challenge

And the honest truth is that there are still improvements - big improvements - that we can and should make to health services in this country. The NHS - like other public services - has benefited from increased investment over the past decade.

The sharp recession of the early 90s - coupled with a Conservative government that was indifferent to the public sector - left Britain’s schools, hospitals and police force in urgent need of more money. And since 2000, they have had it - lots of it.

The NHS itself has had an average 7% increase in its budget for each of the past six years.

But neither the public nor a growing number of health economists believe that those resources have been spent as efficiently as they should.

The reason is that increases in public spending have been accompanied by the politics of big government. More money has been given on the condition that central government decides how to spend it.

Central directions, onerous inspections and a myriad of bureaucratic targets. These have been the hallmark of New Labour governance. Micromanagement, waste and skewed priorities have been its by-products.

The NHS is a prime example - extra money but effectiveness damaged by central control. Gordon Brown likes to talk about record levels of investment in the NHS on Labour’s watch. And the Government’s success in reducing waiting times.

Shorter waiting times and improved recovery rates for heart disease and other illnesses are indeed a testament to extra resources, as are improved technology and, of course, increased numbers of NHS staff.

These are real achievements. But as the economy tightens Gordon Brown is finding that it is no longer possible to prime the pump with more money directed towards his priorities.

And last year’s Wanless Report brought into sharp focus Labour’s failure to get value for money from the sum of money that has been poured into it. A grandiose IT project running years behind schedule and billions over budget. GP and consultant contracts poorly negotiated with no clear benefit for patients. And an endless cycle of botched reorganisations that have seen PCTs established, then merged - Community Health Councils and their successors abolished.

And now the Healthcare Commission, the Commission for Social Care Inspection and the Mental Health Act Commission all merging after just a few years of existence.

Terrified by the prospect of genuine local control Labour has dictated health policy from the centre.

Local spending priorities and enormous bureaucratic reforms have been planned in Whitehall and controlled from the desk of the Secretary of State.

The result is stark mismanagement of the NHS. And a failure to play its part in tackling the multiple causes of Britain’s health inequalities.

Ten years ago the infant mortality rate among the poorest families was 13% higher than that for the wealthiest. Today, it is 17% higher. The great experiment in Big Government Solutions has failed.

But recent instructions from the government that Primary Care Trusts must implant a GP-led health centre or polyclinic in every community suggest that government policy is still heading in the same failed direction. The desire to control from the centre remains at the heart of government policy.

So the question facing politicians today is this: how can we move beyond the centralising agenda?

How can we deliver quality public services - with better, fairer outcomes - without repeating the statist errors of the past decade?

In my view, that is the greatest dilemma for progressive politicians of all parties in Britain today - how to achieve social progress through a new, decentralised state.

The Conservative Approach

The Conservatives claim they understand the failings of over-centralisation and want to do something about it. But where’s the beef?

Haunted by their record in government they are frightened to take any concrete steps necessary to truly decentralise our public services. Today, they offer only cosmetic solutions to the challenges facing our public services.

Trumpeting the merits of Victorian-era charity and volunteerism in education and welfare. And hiding behind the mantra that doctors should take charge of the NHS.

Certainly clinicians should be involved in planning effective healthcare. But the plea from doctors and nurses is that they be freed up to exercise their clinical judgment - not that they should be responsible for shaping local health services.

And the establishment of a national independent board to direct the NHS is no solution. Central control would remain, and the opportunity for democratic accountability would be squandered.

In health - like so many other areas - the Cameron approach amounts to little more than a slick PR campaign intended to decontaminate the Tory brand. But that is not a series programme for government. People deserve to know what a party will do with the power it seeks. Power should be earned, not inherited.

The Liberal Democrat Approach

But there is another way. A liberal and progressive way to deliver real improvements in our public services. And it has three principles at its core.

First, that the role of the central state should be pruned back. So that Whitehall is able to concentrate and deliver on its three key functions:

Ensuring fair distribution of resources, high professional standards, and universal access to public services.

Second, the radical devolution of power and responsibility to those communities that it affects and who understand how best to use it.

And third, the empowerment of individual service users to make their own choices and chart their own path in a way that suits their individual needs.

I have already spelled out what this would mean for education.

Free schools, whereby parents and outside organisations are enabled to create, shape and manage dynamic new schools with high ambitions - under the strategic oversight of Local Authorities. And a Pupil Premium that will ensure added investment into the education of each and every child from a deprived background.

Today, I want to apply those same principles to health:

The pruning back of the central state; the devolution of power to local communities; and the empowerment of individual service users - these principles would transform a much loved but over-centralised and insufficiently accountable NHS into a devolved, responsive and accountable NHS - in short, I want to see the NHS transformed into a true People’s Health Service.

Click here to read part two.

Applicability: this item refers to England. Due to devolution, detailed policy may be different in other areas of the UK.