Commentary (The Times)

Conservatism: “Cameron breaks with Thatcherite past in about-turn over health policy” (drops patient passport)

Document type: Press
Source: The Times , 2 Jan 2006
Journalist: Sam Coates, The Times
Editorial comments:
Importance ranking: Minor
Word count: 1,020 words
Themes: Conservatism, Health policy

Cameron breaks with Thatcherite past in about-turn over health policy

By Sam Coates

DAVID CAMERON is to call for voluntary sector organisations to play a bigger role in providing healthcare, as part of a fundamental rethink on Conservative health policy to be announced this week.

In a break from the past, the Tory leader has also dumped one of the party’s flagship policies from the May general election — the “patient’s passport”. This would have meant the State refunding up to 60 per cent of a private operation and led to accusations that the Conservatives were preparing to dismantle the NHS.

Mr Cameron announced over the weekend in an advertisement that he wanted to “improve [the NHS] for everyone, not help a few to opt out”. He has told colleagues that he wants the party to focus on raising standards through competition and choice.

This comes as the Tory leader warned members of his party not to appear too dogmatic. “For politicians to stick rigidly to an ideology is to court disaster. Nothing can be set in stone.”

He also risked further angering the Right by criticising Baroness Thatcher’s approach to reform of the public services, suggesting they had not been sufficiently flexible.

“At the next election, a whole generation of people will be voting who were born after Mrs Thatcher left office. So when it comes to tackling the big challenges our society faces, I won’t be the prisoner of an ideological past.” He added that he did not believe in the politics of Right and Left but “the politics of right and wrong”.

He also renewed his criticism of Gordon Brown, calling him a “speak-your-weight machine on propaganda” who behaves like a creature of the past. “He sweeps his hands across the dispatch box like he’s about to throttle somebody. I think he’s very much a 1980s politician.”

A source close to Mr Brown said last night: “We are not going to respond to this sort of thing.”

On Wednesday Mr Cameron will make a speech at The King’s Fund, where he is expected to announce the creation of a commission to examine the party’s policies on health.

He has repeatedly issued warnings about the problems of a “monolithic” National Health Service. During the leadership election he said that the NHS must be radically opened up to competition from a range of private and voluntary health providers. “Health reform must mean the right for any provider to supply NHS operations, not just a few hand-picked companies,” he said.

The greater use of the voluntary sector is likely to be a key battleground area between Mr Cameron and Mr Brown at the next general election.

Last month at the Hugo Young Memorial Lecture, the Chancellor made clear that he did not believe the voluntary sector should be used to replace the State.

“Our voluntary organisations should neither be captured by the State nor used as a cut-price alternative to necessary public provision . . . and [we should] reject any New Right view of the voluntary sector as a weapon in the battle against any role for government – a view that takes us backwards into a old world of paternalism,” he said.

Mr Cameron is expected to draw on his experience of the NHS with his young son, Ivan, who was born severely disabled, which he has said has shaped his views about the need for reform.

“It has strengthened my commitment to the NHS, but it has also made me realise how much we need reform — the lack of an authority figure on the ward, the failure to have efficient accident and emergency services, the time you can spend waiting in hospital all need to be addressed,” he said during the election campaign.

He is also expected to back moves to give hospitals greater autonomy. “The monolithic health service is ripe for reform and I want to see more strong, independent hospitals.”

Mr Cameron has insisted repeatedly that the NHS must remain free at the point of delivery, and said at the weekend that he would “share the proceeds of growth” under a future Tory government between tax cuts and increased investment in public services.

This approach marks a stark contrast with the party’s stance before last year’s election.

The patient’s passport was the brainchild of Liam Fox, the former health spokesman and right-wing leadership contender. The manifesto for the May election said that it would cut waiting times and spoke of the 220,000 people who paid for operations each year even though they didn’t have insurance. 


1979 Politicians realise NHS is becoming the victim of its own success. New technology, rising expectations and increasing elderly population put huge pressures on the service

1982 NHS restructuring to simplify organisation

1983-1985 Management introduced for the first time after Griffiths’ Report; doctors encouraged to become more involved with budget decisions

1986 Margaret Thatcher oversees wide-ranging review of primary care services for the first time in history of NHS

1989 The so-called internal market was outlined in the White Paper, Working for Patients. It passed into law as the NHS and Community Care Act 1990

1991-1995 Biggest reforms:

  • Health authorities cease to run hospitals directly and “purchase” care for their populations from “providers” — hospitals/other health organisations
  • GPs offered “fundholding budgets” to purchase care. Those who did not have budgets were controlled by health authorities, which bought health care “in bulk” from NHS trusts
  • Patients of GP fundholders could often obtain treatment more quickly, leading to accusations of the NHS operating a two-tier system

    1997 Labour come into power and abolish the NHS internal market

    2001 Conservatives pledge to meet Labour’s spending plans, as well as promoting growth in the private sector. Health authorities will eventually be phased out. Extension of the use of private health insurance. The party proposes to end “tax penalty” on those taking out private insurance

    2005 The Tories want to abolish all targets, free all hospitals to become foundation trusts, and create “patient passports”

    2006 Conservatives announce a fundamental review, drop “patient passports”, Cameron guarantees it will be free at point of delivery