NORMAN LAMB ADDRESSES THE LIBERAL DEMOCRAT AUTUMN CONFERENCE

11.10.00am BST (GMT +0100) Tue 18th Sep 2007

Full text from Norman Lamb's speech at the Liberal Democrat Autumn Conference 2007, Brighton, 18th September 2007.

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I've got a confession to make. I was a smoker - on and off - a stress smoker, I guess. Elections, party conferences - that sort of thing drove me to it!

I got caught out last year - at a particularly stressful moment - having a cigarette behind the Grand hotel - by Michael White, who duly exposed me in the Guardian diary the next day.

But this job - I can honestly say - is good for you. Because I have given up. I have done the 10 k London run, raising money for a Norfolk hospital and I have lost half a stone.

Even though I was 50 on Sunday, I can honestly say I am healthier than when I took on the job.

However, I'm not sure where it's all leading: I was somewhat concerned last week when this envelope arrived in my office: 'For the attention of Norman Lamb's Care Worker'. I think - and hope - they meant 'caseworker'. We will see.

Can I acknowledge, right at the start, the really talented health team we have in both the Commons and Lords - and the health working group. It is a privilege to work with them.

Over this last 9 months, I have been determined to get out and listen to doctors and nurses about the NHS and to the patients about their experiences of the care they have received.

I have witnessed extraordinary dedication and professionalism - the calm efficiency of staff working in Accident and Emergency late at night under great pressure; an immensely impressive ambulance paramedic out on the road; highly skilled nurses looking after the tiniest premature babies in a neonatal unit - a humbling experience.

Those who work in the NHS, from the lowest paid cleaner to the surgeons conducting life-saving operations - they all deserve our respect and appreciation.

And I have talked to patients whose lives have been saved and transformed by our National Health Service.

And it is OUR NHS.

It is a great British institution - designed by a Liberal - William Beveridge. We will always fight to protect it and to enhance it.

However I have also witnessed some of the intense frustrations of patients, staff and local communities.

I remember the health visitor in Sedgefield who told me she was on her 5th employer since 1987 whilst doing exactly the same job.

I remember at the heart of that constituency, the health centre at Newton Aycliffe - palpable neglect, paint peeling, a down at heel building - and this in the former Prime Minister's own constituency.

As services have been cut back because of financial crisis, GPs in my own county of Norfolk have told me of youngsters with mental health problems denied essential support.

I have talked to community activists campaigning alongside our candidate, Stephen Lloyd in Eastbourne against the threat of losing their maternity services. They knew that the local Primary Care Trust was not listening to them. You know why? Because they didn't have to.

What have I learned?

Well, the first lesson is: We must never return to the horror of chronic underinvestment by the Conservatives when they were in Government.

By 1997, we were spending one third less on healthcare compared to the rest of the EU. That is not just bad policy, it's criminal neglect!

And the consequences? People waiting years for knee and hip operations; a massive shortage of doctors and nurses, cancer and stroke survival rates running well behind the rest of Europe.

Just two years ago, David Cameron wrote a manifesto which proposed that the NHS would be drained of funds as money flowed into subsidizing private health care. Who can trust the Tories now on the NHS? At the first sign of losing support, David Cameron shifts right - into territory where the mass of his party - and John Redwood - stubbornly sulk.

Most of them just don't believe in the core principles of our National Health Service.

Let's be clear: Liberal Democrats have to fight to ensure that never again will the UK fall behind Europe on funding for health. When the money is short it is always the poorest who suffer most. They have no voice and precious little choice; we must speak up for them.They do not have the option of private care.

So we applaud the Government for the investment they have made in the NHS - following the demands made by this party.

That brings me to my second conclusion. Investment is not enough, if reform that goes with it is incompetent.

Real progress has been made but so much of that investment has been wasted.

Just look at the conclusions of the Wanless report last week - a damning critique of the Government's stewardship of the NHS. And this from the man brought in by Gordon Brown to advise on the need for extra investment in the NHS - deeply embarrassing for the Prime Minister.

The charge sheet against Labour is devastating.

So many botched reorganisations. Primary Care Trusts established then merged, Community Health Councils abolished and then their replacement bodies abolished too.

The contracts for GPs and consultants - massively over budget - with no clear benefits for patient care;

The grandiose national IT programme, running years behind schedule and billions of pounds over budget;

The junior doctor recruitment fiasco;

Increasing rates of hospital acquired infections,

Billions committed to PFI projects without any proper budgeting for the ongoing commitments. Mortgaging our country's wealth and health.

Debts running out of control, leading to cuts in public health budgets, mental health services and staff training. Boom and bust hasn't been banished under Gordon Brown. It is alive and well in the NHS.

This is Labour's record, Gordon Brown's record on the NHS - a record of incompetence, inconsistency and confusion.

So what are the fundamental principles that, I believe, must underpin the Liberal Democrat vision for the NHS?

I have identified four:

• Fairness

• Efficiency

• Empowering patients

• Empowering communities

First, Fairness. It is totally unacceptable to Liberal Democrats that, under this Government, health inequalities have increased.

Life expectancy for men in Kensington and Chelsea is 82 years. In Manchester, just 72.

And accident of birth in modern Britain affects your very chance of survival. In the most affluent communities, there are about 3 infant deaths per thousand live births compared to 9 per thousand in the most disadvantaged. Almost three times higher. This is Great Britain in the 21st century. Ours is a divided society.

What does the Government offer in response? £120 to every pregnant woman to spend on food. Pathetic! It's a gimmick intended to grab headlines rather than help those in real need.

Whilst the causes of health inequalities go well beyond the NHS - poor housing, education, poverty and so on - it is nonetheless clear that the health service has a vital role to play.

The GP contract, for example, provides a disincentive for doctors to practice in deprived communities where there are already fewer GPs per head. This must be reformed.

And ethnic minority communities are also losing out.

The NHS is under a legal duty to promote race equality - but because of serious concerns, the Commission for Racial Equality has launched a formal investigation into the Department of Health.

But let me just look at one area where more effective use of resources could help lift people out of poverty.

The Government's own adviser on mental health, Lord Layard, has highlighted how over a million people with mental health problems receive incapacity benefit but are denied access to psychological therapies which could help them back to work. This is appallingly short-term thinking and a dismal waste of human talent.

Liberal Democrats would make this cost effective investment. We would join up thinking between the departments of health and Work and Pensions.

Mental health is costing the economy an estimated £23 billion a year in England alone in economic inactivity and social exclusion.

One in six adults has a current mental health disorder. So many families touched by the anxieties and fears that this brings.

Despite some improvements, it remains all too often a Cinderella service.

Funding increases have not kept pace with other areas of healthcare.

I want our party to champion the interests of those with mental health problems; to improve access to services, to ensure service users are treated with dignity and self respect. This must be a top priority for us.

The second principle is the efficient use of resources in securing high quality healthcare - the very issue highlighted by Wanless.

Every penny wasted is money not going into patient care.

We need more effective commissioning to get the best deal for patients; we must break down the costly barriers between health and social care and help patients with chronic conditions to manage their condition at home avoiding the revolving door of repeated emergency admissions; getting services out of acute hospitals - when they don't need to be there - and getting them closer to peoples' homes.

As a Liberal Democrat, my real passion, what I am about, is fighting to give power to those who have no power - to give them a voice, to enable people to flourish as full citizens. That cause is as important in health care as in any other facet of life.

So my third principle is empowering patients.

Labour claims to be in favour of choice, but it is choice on Labour's terms. Too often the patient is not really involved in the key decisions about their care, about the type of treatment they should get and which specialist they should be referred to. Under a Liberal Democrat NHS, it is for the patient to make these decisions and given the information to do so - guided by their GP and our proposed new patient advisers.

In social care, direct payments and individual budgets, pioneered by disabled people themselves, have given them control over how money is spent.

Studies highlight the extent to which this empowers and dignifies people and gets the money spent more effectively. There is real potential for extending direct payments into the NHS.

Is there scope for giving the patient suffering from a chronic condition more control over their care in this way?

Perhaps even giving a pregnant woman the chance to use her NHS money on an independent midwife so she has the birth that she wants - giving every woman that choice not just the few. These radical ideas should be piloted.

Giving power to patients also involves giving them information so that they can make genuine decisions about their treatment. Information about the types of treatment available and about the quality of care.

Patients are also entitled to know what they can expect from the NHS and what is expected of them. A patient's contract.

As a Liberal, I believe in the principle of responsibility going hand in hand with freedom - responsibility to our fellow citizens and to our wider community. I want to see a debate about what this should mean in terms of the NHS.

Finally, the crucial question of control and accountability.

Poor Hazel Blears - the Labour minister. There she was - like any good citizen - innocently protesting against a plan to close a maternity unit in her constituency.

What she found, like the rest of us, is that the bodies making these decisions were not accountable to their local communities. Primary Care Trust boards are appointed nationally - and are in turn accountable to Strategic Health Authorities - whose boards are also appointed nationally. They are accountable to the Secretary of State. Command and control from Whitehall.

Former Health Secretary, Patricia Hewitt, may not be the nation's favourite politician but just before her demise, she saw the light.

The NHS she said is four times the size of the Cuban economy and more centralised. There is a democratic deficit, she said.

Given that she was in such an enlightened frame of mind, she could have gone on to reflect on the fact that we raise a far higher proportion of our taxes centrally than any other country in Europe - apart from Malta - and they probably have some justification!

But neither Gordon Brown's Labour Government nor David Cameron's Conservatives will do anything about this. The centralising instincts of both these parties have generated a dependency culture in this country. We have no power over our own destiny to shape local services to meet local needs. All we can do is blame the Government - and nothing happens.

My vision is of establishing genuine local democratic accountability - not glorified focus groups as Labour propose today- local control and local responsibility with some revenue raising powers. In Denmark and Sweden we saw local control in action. These are countries which empower local communities and deliver high standards of health care for their citizens.

I want the Liberal Democrats to be at the heart of the debate about the future of the NHS. I want a modern liberal vision to shape the NHS.

A vision like this: "More power to the individual, more power to the local community, less centralised government - a country of free men and women controlling their lives, exploiting choice and competition but backed up by services - also as far as possible locally provided."

Jo Grimond said that. As relevant now as it was then.