Chapter 4
Our NHS: Free to all, personal to each
Forward to personalised healthcare
for all of us, not back to two-tier
healthcare
1997: 12-hour waits in Accident and Emergency,
and waiting more than 18 months for
operations
2005: Less than four hours in A&E for 97 per
cent of patients. Virtually no one waiting
more than nine months for an operation
2008: No one waiting more than 18 weeks from
referral to treatment. No hidden waits.
Free choice of hospital
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The NHS is being restored to good health: more doctors,more
nurses, better facilities.Waiting times are coming down and
the survival rates for the biggest killers are improving.The
revolution in quantity of care must be matched by a revolution
in quality of care.With equal access for all and no charges
for operations. That means new types of health provision,
more say for patients in how, where and when they are treated,
and tackling ill-health at source.
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The new Labour case
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Healthcare is too precious to be left to chance, too central to life
chances to be left to your wealth. Access to treatment should be based
on your clinical need not on your ability to pay.This means defeating
those who would dismantle the NHS. But it also means fundamentally
reforming the NHS to meet new challenges – a more demanding
citizenry with higher expectations, major advances in science
and medical technology, changes in the composition and needs of the
population.
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So our aim is an NHS free to all of us and personal to each of us.We
will deliver through high national standards backed by sustained
investment, by using new providers where they add capacity or promote
innovation, and most importantly by giving more power to
patients over their own treatment and over their own health.
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We promised to revive the NHS; we have. In our third term we will
make the NHS safe for a generation.
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New investment
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NHS spending has doubled since 1997, and will triple by 2008;
already we have an extra 27,000 doctors in post or in training and
79,000 extra nurses; over 100 new hospital building projects under
way; 500,000 more operations a year.We are proud of the dedication
and commitment of NHS staff.We have widened the responsibilities
of nurses and pharmacists, paramedics and porters, creating health
services more convenient for patients.
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Together with our organisational reforms, the investment is paying off.
The maximum time that people waited for operations in 1997 was
well over 18 months. Now virtually no one waits longer than nine
months, and this year it will fall further to six months.For a heart operation
or for cataract removal no one is waiting longer than three
months; 97 per cent of people wait less than four hours in Accident
and Emergency before treatment, admission or discharge. And speedier
treatment saves lives. Death rates from heart disease are down by
27 per cent since 1996; from cancer by 12 per cent.
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We will do even better. For too long waiting times have only counted
the time after diagnosis.We will be the first Government to include all
waiting times in this calculation, including waiting for outpatient
appointments and for test results.There will be no hidden waits. So:
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* By the end of 2008, no NHS patient will have to wait longer than a
maximum of 18 weeks from the time they are referred for a hospital operation
by their GP until the time they have that operation.This would
mean an average wait of nine to ten weeks.
*We will commit to faster test results for cervical smears.
*We will go further in improving cancer waiting times.
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All this with equal access for all, free at the point of need with no
charges for hospital operations.
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We have tightened the rules on NHS operations so that ‘health tourists’
now have to pay for treatment.
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We will deal with the challenge of MRSA. Infections acquired in hospital
are not new.The time to destroy MRSA was in the early 1990s –
when only five per cent of the bacteria were resistant to antibiotics. At
that time the Tory government did not even keep records about the
incidence of MRSA and were forcing hospitals to contract out cleaning
services.We were the first government to publish statistics on the
problem. Now, thanks to the tough measures we have already taken,
including the end to a two-tier workforce for contracted-out cleaning
services, MRSA rates are on their way down. But there is still some
way to go.We all want clean hospitals, free of infection.We have already
reintroduced hospital matrons and given them unprecedented powers
to deal with cleanliness and infections in their wards;we shall reinforce
this by consulting on new laws to enforce higher hygiene standards
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And by strengthening accountability and cutting bureaucracy,we shall
ensure that the new investment is not squandered.We are decreasing
the numbers of staff in the Department of Health by a third, and are
halving the numbers of quangos – freeing up £500 million for frontline
staff. Given the pace of change within medical services we will
ensure that it is possible for the NHS to change the way in which it
organises its services as quickly as possible.Further streamlining measures
will allow us to release an additional £250 million a year for frontline
services by 2007.
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In the light of the findings of the Shipman Inquiry, we will strengthen
clinical governance in the NHS to ensure that professional activity is
fully accountable to patients, their families and the wider public.
Following the recommendation of the Health Select Committee, we
will require registration of all clinical trials and publication of their
findings for all trials of medicinal products with a marketing authorisation
in the UK.
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Innovation and reform
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To achieve our goals we need to expand and develop different types
of provision.We will put more money into the frontline, develop practice-
based commissioning, and so ensure that family doctors have
more power over their budgets.We will create more services in primary
care.We will build on our family doctor service with more GPs
delivering more advanced services more locally; new walk-in centres
for commuters; specialised diagnostic and testing services; comprehensive
out-of-hours services; high-street drop-in centres for chiropody,
physiotherapy and check-ups. And we will continue to
expand the role of nurses. These changes will result in more quality,
convenience and care.
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Expansion in NHS capacity will come both from within the National
Health Service – where we will develop the NHS Foundation Trust
model and the new freedom for GPs to expand provision – as well as
from the independent and voluntary sector, where specialist services
are available at NHS standards to meet NHS need.
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To help create an even greater range of provision and further improve
convenience,we will over the next five years develop a new generation
of modern NHS community hospitals.These state-of-the-art centres
will provide diagnostics, day surgery and outpatients facilities closer to
where people live and work.
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We shall continue to encourage innovation and reform through the
use of the independent sector to add capacity to, and drive contestability
within, the NHS.We have already commissioned 460,000 operations
from the independent sector, which will all be delivered free –
with equal access for all based on need, not the ability to pay.
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Whenever NHS patients need new capacity for their healthcare, we
will ensure that it is provided from whatever source.
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Empowering patients: choosing not waiting
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One principle underpins our reforms – putting patients centre stage.
And extending patient power and choice is crucial to achieving this.
We shall be embedding both throughout the NHS. So:
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* By the end of 2008, patients whose GPs refer them for an operation will
be able to choose from any hospital that can provide that operation to
NHS medical and financial standards.There will be the choice of a convenient
time and place for a non-urgent operation for example a location
close to relatives.
*We will expand capacity and choice in primary care too.Where GPs’ lists
are full we will expand provision by encouraging entrepreneurial GPs
and other providers to expand into that location.
* By 2009 all women will have choice over where and how they have their
baby and what pain relief to use.We want every woman to be supported
by the same midwife throughout her pregnancy. Support will be linked
closely to other services that will be provided in Children’s Centres.
* In order to increase choices for patients with cancer we will double the
investment going into palliative care services, giving more people the
choice to be treated at home.
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By October 2005 we will have recruited more than 1,000 new NHS
dentists and will have increased the number of dental school places by
25 per cent.We will undertake a fundamental review of the scope and
resourcing of NHS dentistry.
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We will provide more information and advice.Through NHS Direct,
Health Direct, interactive TV, print media and the internet we will give
more convenient access to much better information about health and
health services, including the performance of doctors and hospitals.
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Empowering patients:
long-term conditions and social care
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We will promote the integration of health and social care at local level,
so that older people and those with long-term conditions can retain
their independence.We will continue to provide healthcare free in
long-term care establishments, and provide the right framework for
schemes such as equity release which make staying at home an attractive
option.We will develop our policy of community matrons for those
with severe conditions, helping to keep people out of hospital by providing
better care at home.
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*We will develop personalised budgets in social care where people can decide
for themselves what they need and how it should be provided.
*We shall extend case-management for the 18 million people with long-term
conditions.We will treble the investment in the Expert Patients Programme,
and help many more patients take control of their own care plans.
* Almost a third of people attending GP surgeries have mental health problems
and mental health occupies approximately one third of a GP’s time.
So we will continue to invest in and improve our services for people with
mental health problems at primary and secondary levels, including
behavioural as well as drug therapies.
*We shall provide safeguards for the few people with long-term mental
health problems who need compulsory treatment coupled with appropriate
protection for the public.We shall also strengthen the system for protecting
the public from offenders who have served their sentence but may still
pose a threat because they have a serious psychopathic disorder.
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Living healthier lives
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People want to take responsibility for their own health outside the
NHS as well as within it.They have the right to expect help from government.
The killer diseases of the heart and the many forms of cancer
are often the product of poor diet, lack of exercise and above all smoking.
By 2010 we aim to reduce deaths from coronary heart disease and
strokes by 40 per cent from 1997. And we want death rates from cancer
to be cut by 20 per cent.
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Healthy choices for children
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We will start the drive for better health early – at school.We have
already extended the provision of free fruit to all 4- to 6-year-olds at
school.We will invest more in renovating and building new kitchens as
well as investing an extra £210 million in school meals, guaranteeing
that at least 50p per meal is spent on ingredients in primary schools,
and at least 60p in secondary schools.We are introducing an independent
School Food Trust, better training for dinner ladies and
Ofsted inspection of healthy eating.We will legislate for tougher standards
of nutrition for school meals and will encourage schools to teach
more about healthy eating.We will ban certain products that are high
in fat/salt content from school meals and ensure that fresh fruit and
vegetables are part of every school meal.We will encourage secondary
schools to keep pupils on the premises to ensure that they have a
healthy meal.We will ensure that all school children have access to a
school nurse.
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Healthy choices for all
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We will put in place a simple system of labelling to make it easier for
busy shoppers to see at a glance how individual foods contribute to a
healthy balanced diet.We will help parents by restricting further the
advertising and promotion to children of those foods and drinks that
are high in fat, salt and sugar.
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We recognise that many people want smoke-free environments and
need regulation to help them get this.We therefore intend to shift the
balance significantly in their favour.We will legislate to ensure that all
enclosed public places and workplaces other than licensed premises
will be smoke-free.The legislation will ensure that all restaurants will
be smoke-free; all pubs and bars preparing and serving food will be
smoke-free; and other pubs and bars will be free to choose whether to
allow smoking or to be smoke-free. In membership clubs the members
will be free to choose whether to allow smoking or to be smoke-free.
However, whatever the general status, to protect employees, smoking
in the bar area will be prohibited everywhere.
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These restrictions will be accompanied by an expansion of NHS
smoking cessation services to encourage and support smokers to
improve their own health by giving up smoking
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Starting with the poorest areas of the country we will introduce health
trainers to help people maintain their healthy choices. By 2010,
through this activity we plan to reduce the health inequalities that exist
between rich and poor.
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All this will be free at the point of need.
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The choice for 2010
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Today’s Conservatives want to do what not even Margaret
Thatcher would countenance – introducing charges for hospital
operations so that those who can afford to pay thousands of
pounds can push ahead of those who cannot. As well as ending
the founding principle of the health service, this would take
more than £1 billion out of the system to subsidise those who
can afford to pay. For the rest of us, the Tories would abandon
waiting-list targets and allow a return to the 18-month waits
that were their NHS legacy. The choice is forward with new
Labour to a health system with patients in the driving seat, free
to all and personal to each of us. Or back with the Tories to longer
waits, and to a health system where treatment depends not on
your condition but on your bank balance.
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