Blair on offensive over Tory 'right to charge' policy

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The Government will today offer all patients the choice to be treated at any NHS or private hospital as its steps up the political battle over health by matching a Tory pledge made yesterday.

The Government will today offer all patients the choice to be treated at any NHS or private hospital as its steps up the political battle over health by matching a Tory pledge made yesterday.

A five-year plan to be unveiled by the Health Secretary, John Reid, will set a new maximum waiting time between GP referral to treatment of four and a half months by 2008, including a maximum three-month wait at any stage of the process. The current target is a maximum waiting time of six months by 2005.

The health plan is being announced on the same day as the government calls by-elections for 15 July in two seats in the first test of Labour's popularity since their poor showing at the local and European elections earlier this month. The contested seats, are Leicester South, vacant due to the death of veteran Labour MP, Jim Marshall; and Birmingham Hodge Hill, which is being vacated by Terry Davis for a post in Europe.

Labour's health plan is widely seen as a fightback after the election setbacks. It will attempt to break down the barriers between the NHS and private sector by extending significantly its plan to give people the choice of treatment in four or five hospitals from next year.

People will be able to choose treatment at any private hospital, paid for by the state, provided that its charges are in line with a new tariff of NHS costs. This "open choice" policy formed a major plank of the Tories' programme announced yesterday. The Government's White Paper will also announce a new target to reduce "inappropriate" hospital admissions by 10 per cent because 5 per cent of patients take up 40 per cent of bed time. Older people with chronic diseases will be looked after in the community and have "personalised care plans". Other targets will aim to tackle smoking and child obesity.

Mr Reid believes Labour's "open choice" policy will allow it to make the issue of who pays the dividing line between the two main parties at the general election next year. A Tory government would give people 50 per cent towards the cost of private treatment, while under Labour all treatment would be free.

Tony Blair clashed with Michael Howard in the Commons yesterday as their alternative visions of "choice" moved to the top of the agenda. The Prime Minister branded the Tories' "right to choose" policy as "the right to charge" and was "delighted" they had decided to make the NHS "the battleground for the next election".

He told the Tory leader: "We are, as capacity expands, introducing the right of choice in the health service. You are introducing a right to charge that will mean patients end up having to pay 50 per cent of the cost of their operation. What a typical Tory measure, that people will reject."

Mr Howard retorted that 300,000 people each year were already paying 100 per cent of the cost of going private, saying the numbers had risen threefold since Labour came to power.

He said: "There are two visions for the future of the NHS. There's the Labour vision: more targets, more bureaucrats, more centralisation, less freedom for doctors and nurses, and phoney choice for patients. And there's the Conservative vision: an end to centralisation and targets, real freedom for doctors and nurses and the real right to choose for patients."

In a speech later on public services, Mr Blair said it was time to "accelerate reform" and "recast" the welfare state, transforming it from a "one size fits all" to "a high quality consumer service".

His goal was "modern services which maintain at their core the values of equality of access and opportunity for all; base the service round the user, a personalised service with real choice, greater individual responsibility and high standards; and ensure in so doing that we keep our public services universal, for the middle classes as well as those on lower incomes, both of whom expect and demand services of quality."

The Prime Minister admitted Labour had suffered "setbacks aplenty" during its seven years in power but insisted that there had been "real and tangible achievement and progress for many who otherwise would have been kept down, unable to realise their potential, without much hope and with little prospect of advance.

"Now we have to take it further ­ always with an eye to the future, always maintaining the coalition of the decent and the disadvantaged that got us here, always recognising that in politics if you aren't adventurous, you may never know failure but neither are you likely to be acquainted with success. There is still much to do and we intend to do it," Mr Blair concluded.


Dr Beverly Malone, general secretary of the Royal College of Nursing

"Last month, RCN members voted overwhelmingly to reject the idea of the patient passport, with some nurses describing it as an exit visa out of the NHS. I believe nurses are right to be worried. I am concerned that these proposals may extend choice for those who have the necessary resources, but not for everyone - particularly those who are trapped geographically and don't have the resources to travel or to navigate their way through the system. What patients really want is quality patient care close to home, not to have to travel around the UK to gain access to what should be available on their doorstep. The challenge for any party in government is to demonstrate beyond doubt that plans to use the independent sector to provide NHS treatment will not compromise the founding principles of the NHS - free, equitable access to health care for all."

Gill Morgan, chief executive of the NHS Confederation, representing health service managers

"Our biggest concern about the Tories' patient passport is what it will do to costs in the private sector. For some years we have had the most expensive private sector in the world, but recently we have seen prices tumbling because waiting lists have come down and independent healthcare companies have had to be more competitive. The concern is that the passport could fuel reinflation in the private sector, and that would be a real shame as it would not help patients or the NHS. I do think, however, that the plan for scrapping targets is a good one. They are not talking about getting rid of minimum standards - the plan would be to take away targets set from the centre. At the moment, there is a gulf between the people who set the targets and the people who have to deliver them. They can often seem irrelevant. Devolving them to local level could give people real inspiration."

George Ray, chairman of the British Medical Association's annual representative meeting, taking place next week

"What doctors are really tired of is the incessant change we have had to cope with in the way the NHS is run since the 1990s. We need a bit of stability, and all the main parties should recognise that. No sooner have we got to grips with running things one way than we are told we have got to deliver them differently. We have got change fatigue. We support the idea of patient choice in principle, but I think Labour's plans to offer an unrestricted choice of hospitals is unrealistic. It could be very bureaucratic and wasteful of National Health Service resources and time, as GPs would have to go through all the hospitals with a patient. GPs build up a close and valuable relationship with consultants at their local hospitals - the idea of unrestricted choice could lead to fragmentation of the service."

Michael Summers, chairman of the Patients' Association

"There is not a great deal of difference between the two main parties on health policy now. I am a little concerned about this emphasis on using the private sector as a substitute for capacity in the NHS. I think we should get away from this and both parties should spend their time and their money trying to improve the NHS. We do believe that patients should have the right to choose, but I don't think the Tories have got the approach right with their patient passport. If they give money to people to help towards the cost of a private operation, that is not money that is going into developing the health service. I am also worried about the Conservative plans to scrap all targets and let hospitals set their own. I don't see how you can run the NHS without some targets - poorly-performing hospitals will simply set themselves lower targets. Labour has put a lot of money into the NHS since it came to power but the main complaint we hear from people is that they are still waiting too long. John Reid has said that he will reduce the waiting-time target to four and a half months, but if you are in pain, that is still a long time to wait."