The National Health Service will be a battleground at the general election after the Tories pledged yesterday to meet 60 per cent of the cost when people opt to use the private sector for treatment.

Liam Fox, the shadow Health Secretary, told the Conservative Party conference that a Tory government would bring in "passports" to allow patients to recoup three-fifths of the NHS price when they go private.

He said the Tories would "give a helping hand" to people without health insurance who use their savings to pay for treatment. He said the number had risen threefold to 300,000 a year since 1997.

Last night ministers accused the Tories of abandoning the NHS principle of free treatment at the point of need. John Reid, the Secretary of State for Health, said the Tory proposals would mean "subsidising private operations for those who can already afford it".

He said the choice at the next election would be between "a 21st-century NHS with Labour, free at the point of need, or being forced to pay for care under the Tories".

Mr Reid warned that the Tories' decision to extend the "patients' passports" to chronic illnesses could leave people with huge bills as they met 40 per cent of the cost of long-term treatment. He claimed that under the Tory plan people would have to pay £9,500 towards a heart bypass and £6,500 towards a knee replacement.

But Dr Fox, a former GP, insisted that all would benefit from the Tory proposal. A patient waiting for a hip replacement costing £5,000 could go to the NHS or receive £3,000 towards the cost of private treatment. "That would leave £2,000 to help the NHS and the queue would have got shorter. Everyone should get a helping hand ­ choice should not only be available for the rich," he said.

Dr Fox said that the people going private often used their savings to spare themselves a wait. "Despite the fact that they have already paid for their health care, often through a lifetime of contributions, the state will give them no help whatsoever," he said.

He explained that a Tory government would take the politicians out of the day-to-day running of the health service by setting up an independent NHS board.

"It cannot be managed from behind the Secretary of State's desk. The NHS is too big, too diverse and too complex," he said. Dr Fox said that for too long the allocation of health funding had been shrouded in mystery and used as a tool of political patronage.

He promised to scrap Labour's targets for the NHS, saying that removing the need to have people monitoring them and giving power to frontline staff would render "Whitehall babysitters" redundant.

Dr Fox defended proposals to introduce health screening for immigrants to stop the spread of disease and prevent "health tourists" abusing the NHS. He warned critics that they were playing into the hands of the far right.

"If we, in the political mainstream, are not willing to deal with these issues in a reasonable and responsible way then there will be those on the darker edges of our politics who will exploit them."

More bureaucracy, more inequity

By Jeremy Laurance

There are three problems with the Tories' scheme for NHS vouchers. First, it will increase bureaucracy ­ extra administrators will be required. Second, it will increase inequity by helping the better-off to get treatment quicker.

The third and biggest problem is that it will drain funds from the NHS without expanding the total provision of health care, which is the Tories' avowed aim.

Experience shows that tax concessions are used by the rich to subsidise purchases that they would have made anyway.

The big change in private medicine since 1997 has been the growth of the self-pay market, where people pay for treatment as they need it, which has tripled from 100,000 operations to 300,000. This has occurred without the incentive of vouchers.

The Tories want to encourage the trend. But even if they are successful, the voucher scheme means subsidising 300,000 people for 60 per cent of the costs of operations which they would have paid for at full price.

The benefit of the Tory scheme is that it will give choice to consumers who can exercise power in the health marketplace, loosening the iron grip of the NHS as a monopoly provider. But it ignores the needs of those with chronic illness who cannot get private care but who consume 75 per cent of NHS resources.

The danger is that the Tory scheme will leave the NHS as a rump service for the poor.

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