David Laws: The NHS needs more than just more money

From a speech delivered by the Liberal Democrat MP for Yeovil to a meeting of the Liberal Future think-tank in London

At a recent constituency advice centre, I saw a lady who had come to complain about the waiting time for an NHS outpatient appointment. She needed to see a neuro-physiologist because of problems with her hands which were causing her pain and making everyday activities difficult.

In December 2001, the lady was given an appointment for April 2002. In January 2002, she received a letter curtly cancelling her April 2002 appointment, and rescheduling this for 9.40am on 9 September 2003 – 20 months away.

There was no real apology or explanation for this delay, though the reason later given was a severe staff shortage in this specialty. There was no indication that any serious thought had been given to treating this lady in another centre, here or even abroad.

Of course, it is always easy to pick out individual cases of a service failure. But this case highlights many of the problems with the NHS – too few resources, lack of imagination about alternative provision, and lack of attention to customer care.

The Government's failure to tackle the issue of resourcing, combined with their conservative and incoherent attitudes to NHS reform, offers a real opportunity for the Liberal Democrats. But we will not seize it unless we think imaginatively about the future of the NHS, instead of pretending that a "better funded status quo" is all that we need.

A press release from the Liberal Democrats, on 11 February 2002, on Government proposals to replace executives at failing hospitals says this: "This is gimmickry gone mad. Everyone knows that hospitals labelled by the Government as 'failing' are only failing because of a shortage of resources and an unwillingness to fiddle the figures."

We make a profound error when we try to pretend that funding is the source of all the problems in our public services. Indeed, we weaken the force of our argument on funding, when we fail to recognise these other problems. As a party, we have not, I fear, been leaders in securing the consumer interest. We do not, for example, consider how the public can be more closely connected to the health services they receive, for example, through a more social insurance based model.

Nor have we considered how the funding systems for health services could offer more choice to consumers.

As society becomes wealthier, people will demand more choice and freedoms. The question is whether we force the minority who can afford it the choice to opt out of the system, so steadily eroding the commitment to the NHS; or whether we gradually build in greater elements of choice and the ability to top-up funding, within the context of a system with sharply improved standards.

Ministers have now had their micro-chips programmed to tell them that the private sector is always more efficient than the public sector. Plainly, this is not always true. Indeed, in some senses, one might say that the NHS has become rather good at "efficiency" in a number of areas, by paying staff as little as possible, with bed usage at close to 100 per cent.

Unfortunately, the results of this "efficiency" are plain to see – staff shortages and huge waiting lists.

It is also true that PFI deals will not always be in the taxpayer interest, and are in many cases being driven by government attitudes to borrowing, and bogus assumptions about discount rates and risk transfers.

But we must avoid going down the Old Labour road that says that "profit" and delivering high standards for the public are somehow inconsistent. In some areas the private sector will prove to be cheaper and more efficient than the public sector, and the competition and choice will serve to drive up standards.

We must make health services accountable to patients, not politicians or producers.