Kenneth Clarke: Health is now the Conservatives' big opportunity

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The Independent Online

I do not pretend to have quick fixes to solve these problems overnight. My experience both as Health and Education secretary showed that reform needs to be patiently and painstakingly crafted, not rushed into with wanton disregard for the disruption created or the cost involved.

If we needed a textbook on how not to manage the National Health Service we could ask Mr Blair to write it. After a 50 per cent increase in NHS funding, 61 of the 231 NHS trusts are in deficit, to a total of £306m. Most of the extra money has gone into larger payrolls and excessive bureaucracy.

Everywhere in the public sector you find targets. It is like living in the Soviet Union in the 1970s. An endless stream of initiatives has been launched and then micromanaged by ministers. This culture of centralism has stifled local initiative and all but eliminated managerial creativity. I remain committed to the principle that the state secures access for all citizens to high quality health and education services on the basis of need.

It is not the principle itself, but its delivery, that needs to be improved and modernised. To me there are four key building blocks the Conservatives need to put in place in order to convince the electorate that we are serious in our commitment to public services.

First, public services are provided for the many, not the few. They are universal and they will continue to be largely funded by taxation.

Second, our commitment to equitable access to public services does not mean they have to be provided by the public sector. The voluntary sector, the private sector and religious bodies all have a distinctive and valuable contribution to make. The state should be wary of being the monopoly provider and where it is, it must be rigorously regulated.

Third, it is no good putting more money into public services without reforms. New money should be used for new approaches.

Fourth, a key objective of reform is greater local ownership of the pattern of public services. Power must be devolved downwards to ensure that services reflect the needs of the communities they serve.

The next Conservative government will inherit an NHS in crisis. The current high growth in health spending is due to end in 2008. What will happen when the Chancellor's foot moves from the accelerator to the brake? Will the car slow or will it swerve and crash? The NHS is also being crippled by a management crisis. The target culture is undermining management initiative and responsibility, and replacing it with a culture of box-ticking and buck-passing.

The education world faces very similar issues, including a spending crisis. The Government's failure to address its spending black hole threatens the effectiveness of both these key public services. Similarly the attempt by ministers to micro-manage the education service from Whitehall is widely recognised to be a dead-end policy which is an insult to the professionalism of teachers.

The government I lead will establish a credible framework for government spending that will allow managers to plan services in a way which reflects the priorities of the communities they serve. And it will stop the constant meddling which has been the hallmark of the Blair premiership.

Finally we shall approach all the fashionable ideas for yet another round of management upheaval in healthcare and education with a healthy dose of scepticism. No structure lasts for ever, but my experience of wholesale reform of both the NHS and the schools service is that ambitious reform strategies seldom deliver the benefits claimed by their advocates.

Our public services need to be subject to a consistent and sustained drive for cost efficiency and quality of service. These twin objectives are not opposites; we shall only deliver successful public services if we ensure that we address both objectives. But neither will be best served by yet another "great leap forward" into the dark.