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TERRY DIGNAN: A free market buccaneer whose
Thatcherite views are popular with the Tory grassroots, Liam Fox responds
readily to invitations to make the journey from Westminster to speak to
party activists. Some in the party's high command are alarmed that Dr Fox's
remedy for an overstretched NHS may give Labour a powerful propaganda weapon.
William Hague, like Liam Fox, says the National Health Service
can't do everything. The private sector, believes the Tory leader, must
be expanded to reduce the burden on the NHS. Supporters of Dr Fox say he
wants Mr Hague to be bold and adopt radical policies to create a much bigger
private sector. But there are signs the party leadership is getting cold
feet, fearing that if the Conservatives follow Dr Fox's instincts, they
may face disaster at the next election.
DR MADSEN PIRIE: The Conservatives managed
to change popular attitudes on home ownership and on private pensions and
there's no reason why they shouldn't do the same on private health care.
DR DAVID GREEN: Well the Conservatives
are very reluctant to have this kind of debate because they're paralysed
by this fear that Labour will say, 'Oh you're against the National Health
Service.'
DIGNAN: First stop is Winchester
where Dr Fox has agreed to talk to the local media. He wants to enthuse
voters with radical ideas to outflank Labour. He'd use public money to
buy private treatment to cut NHS waiting lists. But Labour has got there
first and Doctor Fox will have to try harder to offer distinctive policies
on health.
GREEN: Since the last week or so,
the situation between the parties hardly differs on this question of public/private
co-operation both are now saying pretty much the same thing - let's make
use of the private sector, as a sub-contractor, to the National Health
Service, but with the NHS still in a dominant role, bringing in the private
sector when it's...hasn't got the capacity in the public sector.
DR TIM EVANS: I think the independent sector
is delighted that there is now a consensus across the major political players
and that most senior politicians now recognise there is tremendous benefit
to be had for NHS patients by mobilising the independent sector's health
and social care provision.
DIGNAN: With the parties agreeing
on one issue, Dr Fox has his work cut out to say something new. Still in
Winchester, he's called in at the ambulance control centre.
DIGNAN: Responding to emergencies
requires speed. That's a principle the Conservatives would apply to the
most seriously ill. Under their Patient's Guarantee waiting times for illnesses
such as cancer, would be slashed. But that would be expensive and could
conflict with the party's other guarantee - to cut taxes.
GREEN: This promise of a guarantee
that the Conservatives have given, seems to me to be self contradictory,
because it clashes with their promise to limit the proportion of GDP that
is taken by taxes, because, if they're going to give a guarantee that if
you have to wait more than three months, let's say, for a hip operation,
or a by pass operation they're going to pay for it in the private sector,
well that's going to increase public spending.
PIRIE: When we introduced
the Citizens' Charter we started with a maximum two year guarantee and
then rapidly brought it down over the next few years to one year and then
we began to allocate specific waiting times for specific treatments, depending
on the urgency of the case. There was a problem though - the lists, the
waiting periods tended to creep up again. The lower you bring these lists
the more doctors are ready to refer patients to them. And so, after initially
bringing down the waiting period, the Tories might well find that they
start to rise again, just as Labour did.
DIGNAN: These party activists have
turned out for Dr Fox's first speech of the day. What they don't hear is
that they may be faced with dropping the Patients' Guarantee or scrapping
the Tax Guarantee. The voters want better treatment but how will it be
afforded if taxes are cut? Dr Fox thinks the answer is to get more people
to pay for their own healthcare. Liam Fox says the National Health
Service is no longer the envy of the world. It's not just that Governments
in countries like France spend more on health. More importantly, private
health expenditure is higher too. Dr Fox wants to be frank with the electorate
- unlike some in his party's hierarchy - and spell out how the Tories would
bring about a really big increase in the amount spent on private healthcare
in this country. If we look at private health expenditure as a proportion
of a country's wealth or GDP, the UK spends just one per cent on private
medicine. Italy spends more twice as much, two point three per cent. Germany's
spending on private health is two point four per cent of national wealth,
while in France it's even higher at two point five per cent. Everyone in
these three other countries is covered for a basic level of healthcare.
If you want more you pay more.
GREEN: What those systems do is
they allow, either through insurance or through people paying out of pocket,
they allow individuals to decide, independently of what the government
wants them to do to pay more towards health care. You know just as in
- cars, or food, or holidays, if you want to pay a bit more, you can -
if you've got the money. And you need a mechanism of that kind in health
care, so that people can pay more.
DIGNAN: Liam Fox could try to expand
the UK's private healthcare sector by persuading more people to take out
medical insurance. In the ten years after 1988, the numbers covered in
this way rose from five point six million, then fell, then rose again to
six point one million. To make it a more popular concept, Dr Fox has considered
ideas from free market think tanks to allow the cost of insurance to be
set against income tax.
PIRIE: Realistically the
Opposition could argue that tax relief is the best way of bringing outside
money into health care in Britain. This could be done in the form of tax
relief for individuals, such as for example the old tax relief for private
health care for the over 60's or it could done more generally.
NICK BOSANQUET: We could use tax relief in a targeted
way to encourage people to buy services and insurance cover that is complementary
to the NHS. The NHS is still going to provide the vast majority of services
for people with severe or long term illness but realistically there are
going to be a lot of other services where access is going to be highly
rationed and where additional service funded by private payment can reduce
pressure on the NHS.
DIGNAN: After the speech the sandwiches.
Yet there are limits to Doctor Fox's appetite for giving tax relief for
health insurance. All he's said is that he might remove taxes on cover
arranged by employers for their employees. To force people to go private,
he may be relying on his Patient's Guarantee. Those needing routine NHS
treatment will wait longer than the most seriously ill.
BOSANQUET: If some people decide they want
to wait, other people will go elsewhere and either pay for themselves or
complementary insurance policies will develop which will cover areas where
the NHS is not giving immediate access, that will be a much more - much
better total sum of healthcare opportunities for the individual than we've
got at the moment.
DIGNAN: As a true Thatcherite radical
Liam Fox wants to do for health what Lady Thatcher did for home ownership
in the Nineteen Eighties. Just as she succeeded in making home ownership
the norm, so Doctor Fox wants to see millions more people take responsibility
for paying for their own healthcare. While many in the Conservative Party
want William Hague to back Doctor Fox's ambitious plans those close to
Mr Hague fear it could be too risky. For some it's a question of whether
the party has the courage of its convictions.
PIRIE: I'm sure the Conservatives
won't want to advocate a policy that allows Labour to say look Conservatives
are threatening the NHS - so I think the policy has to be carefully constructed;
it has to be full of reassurances. But there's no reason why the Conservatives
should not win the argument.
DIGNAN: The stakes are high. At
the last election Labour succeeded in persuading many that the Conservatives
planned to scrap the state pension. The party still bears the scars from
Tony Blair's onslaught.
TONY BLAIR: The Conservatives' plans to
privatise the basic state pension and to destroy the foundation of security
in retirement should be one of the central issues in this election campaign
and we're going to make it so.
DIGNAN: Next time voters might
be receptive to claims that extending private health will undermine the
NHS. Some senior Tories are said to be deeply worried.
GREEN: If you put the point to
them, then they will say, "Look it will be a re-run of what happened with
pensions. We tried to reform pensions just before the last election, and
Labour said, "These people are against the pension. They're gonna scrap
the State pension." And they'll be believed for long enough to do harm.
So they're saying - they're saying nothing about the Health Service because
we can't win.
DIGNAN: The last engagement of
the day and Doctor Fox is guest of honour. Many party activists like his
brand of publicity-generating right-wing Conservatism. He wants to go into
the next election campaigning to expand private health insurance.
DIGNAN: The Conservatives are caught
between a desire to be radical and a fear of alienating the electorate.
That's why it's argued there's no coherent policy on health.
GREEN: It's the duty of an opposition
party to encourage a debate, and I - I believe the Tories are being - pathetically
weak, by refusing to do so. People know after fifty years, that the Health
Service is failing. The government itself concedes that it's failing. That's
precisely the classic case for an opposition to make mincemeat of the government,
but they're not doing it.
DIGNAN: There's a feel-good factor
about the Conservatives these days. But it may not last. Doctor Fox is
the star of the grassroots but Labour is on his case. Either he reins in
his free market instincts or he develops a policy which may see him portrayed
as a threat to the NHS.
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