Liberal Democrat spring conference backs radical plans for the health service

The Liberal Democrat Spring Conference today backed plans to radically transform the NHS into a 'people's health service' by empowering individuals and decentralising control to local communities. The measures will set the NHS free from central government control, make it accountable to the people it serves through elected health boards and deliver high quality services to all guaranteed in a 'Patient's Contract'.

Plans contained in the policy paper Empowerment, Fairness and Quality in Healthcare include:

· Guaranteeing every citizen access to a high standard of core healthcare entitlements within maximum waiting times in a 'Patient's Contract'. To make sure that the NHS delivers, patients would have the right to receive private treatment, paid for by the NHS, if the waiting time was not met.

· Introducing a 'Care Guarantee' by spending £2 billion on personal care payments for all elderly people requiring care, based on need and not their ability to pay.

· Directly electing the majority of members of local Health Boards instead of unaccountable Primary Care Trusts, putting people in charge of decisions about their local health services.

· Rolling out the use of direct payments and individual budgets for people with chronic, long-term conditions and mental health services.

Commenting, Liberal Democrat Shadow Health Secretary, Norman Lamb said: "I am thrilled by this result, it is a very significant vote for the Liberal Democrats. The Government's obsession with targets has distorted clinical priorities without giving specific rights to patients. Entitling patients to be treated in a private hospital if their wait breached a defined period would provide a real incentive for local health boards to ensure that hospitals deliver that treatment on time."

The full text of the motion is below:

Conference notes that:

i) The NHS is highly centralised, with communities having limited say over their local health services and individual patients feeling they have little control over the care they receive.

ii) The UK has experienced a growth in health inequalities between the wealthiest and poorest members of society.

Conference is committed to providing healthcare free at the point of delivery and funded by the state through progressive taxation.

Conference therefore believes that the four key principles which should guide health and social care policy are:

a) Fairness: our NHS must function on the basis of fairness and deliver high-quality health services to all irrespective of income, age, condition or location.

b) Patient Empowerment to Improve Quality of Care: our NHS must no longer view patients as passive recipients of care, but instead give people the power and support they need to take control of their lives and their health.

c) Local Democratic Accountability: our NHS must give people a real say in how their local health services are run, and establish proper local accountability.

d) Efficient Use of Public Resources: in delivering high-quality health services, it is incumbent on government to ensure the most efficient use of taxpayers' money.

Conference therefore endorses Policy Paper 84, Empowerment, Fairness and Quality in Health Care, as a statement of the Party's key policies for structuring the NHS and providing health and social care services.

Conference particularly welcomes:

1. Proposals to deliver high-quality health services to all, irrespective of income, on a fair and equitable basis, including:

a) Introducing a Care Guarantee, entitling elderly people to a personal care payment, based on need not ability to pay and setting out the entitlements both of people in need of care and of their carers.

b) Raising the status and importance of improving public health and narrowing health inequalities by:

i) Replacing the Health Secretary with a Secretary of State for Public Health, to prioritise prevention across all government departments.

ii) Investing in more school nurses to educate children and parents about the benefits of a healthy lifestyle.

iii) Ensuring that health promotion and prevention is fully integrated into local community plans.

iv) Concerted action across government to tackle the root causes of ill health and inequalities in health, including high levels of income and wealth inequality, poverty, unemployment, poor housing and environmental pollution.

c) Reviewing the basis on which NICE arrives at its judgements on the cost-effectiveness of treatments to take account of factors such as the impact on carers and measures to help people back to work.

d) Enshrining NICE's independence in statute so that there can be no risk of political interference in the objective assessment of any particular technologies and treatments.

2. Proposals to give power to citizens to take control of their lives and their health care, including:

a) Piloting a network of Patient Advocates dedicated to providing information, guidance and support to patients and carers in navigating the health and social care systems and in providing support in how, most effectively, to use direct payments and individual budgets.

b) Enshrining universal healthcare entitlements in a Patient's Contract between the NHS and the individual.

c) Establishing a constitution for the NHS, enshrining its core principles.

d) Expanding the use of direct payments and individual budgets in the provision of social services, and introducing the concept with pilots in specific areas within the NHS, such as chronic conditions.

e) Piloting publishing 'Patient Reported Outcome Measures' which measure real patient experiences and assess whether the treatment has actually benefited their physical and mental health.

f ) Expanding and developing expert patient initiatives.

g) Reforming the Government's politically motivated and clinically distorting national targets.

h) Ensuring the greatest possible choice and flexibility in the delivery of local health services by giving Local Health Boards the power to develop innovative mechanisms for service delivery in defined areas of care.

3. Proposals to ensure local communities have an effective say in how their health services are run, including:

a) Renaming Primary Care Trusts 'Local Health Boards' with the boards to be locally elected rather than centrally appointed and supported by professionals providing financial acumen and health expertise. Local Health Boards will comprise:

i) Two-thirds directly elected members, administered through the local election cycle.

ii) One-third local authority councillors (from social care authorities), who are already directly elected representatives of their communities.

b) Giving local authorities additional powers to scrutinise and hold all local health care services to account (including where foundation trusts have been established, acute health care and ancillary services), and a clear legal duty on both the relevant social care authority and the local health board to cooperate with each other in providing services in their local area.

c) Switching some of the taxation which funds local services from national to local income tax, as part of a fundamental shift of power away from Whitehall to local communities over the long term, and also giving locally elected health commissioners some freedom to vary local income tax to spend on local health services to complement the NHS Patient's Contract.

d) Establishing a new light-touch regional body made up of representation from local health boards to take responsibility for planning tertiary services such as specialist medical units.

e) Ending the central imposition of Independent Sector Treatment Centres and allowing Local Health Boards to decide how to finance capital projects, in particular whether or not to use PFI for capital projects. To ensure that private sector procurement does not destabilise local NHS provision, as successive governments' attempts to procure both capital (PFI) and services from private sources have done, the following criteria should be applied by Local Health Boards to the procurement of private sector provision in the primary and secondary sectors:

i) The new service should meet all NHS standards for quality, information and communication.

ii) The new service can demonstrate that it provides value for money and does not undermine the local health economy.

iii) That no NHS patient shall receive a diminished service as a result of the introduction of a new provider.

f) Enabling Local Health Boards to negotiate adjustments to the tariff with local providers; in a decentralised system, there should not be an inflexible national tariff.

g) Encouraging the development of 'Public Benefit Organisations'.

4. Proposals to ensure the efficient use of public resources in delivering high-quality services, including:

a) Placing a statutory duty on both Local Health Boards and Social Services Authorities to develop and commission joint services and to establish joint budgets.

b) Creating an independent 'NHS Funding and Advisory Commission' to independently allocate funding to individual Local Health Boards and determine the needs-based funding formula on which the allocation would be based, within an overall framework of objectives and resources agreed by Parliament.

c) Making Local Health Boards subject to a statutory duty to demonstrate efficient use of resources - value for money - and have regard to quality and equity.