Page last updated at 14:33 GMT, Wednesday, 4 January 2006

Can you spot the difference?

By Nick Triggle
BBC News health reporter

Surgeons operating
Both the Tories and Labour believe the NHS should be more market-driven

As David Cameron moves the Tories further to the centre-ground with his first speech on health, it is getting harder to spot the difference between the two major parties on the NHS.

The new Tory leader announced the end of the much-maligned patients passport whereby patients were being offered half the cost of NHS operation to put towards private surgery.

The policy was launched in 2002 when Liam Fox was shadow health secretary and formed part of the party's health policy at the last election.

Instead, Mr Cameron promised under a Tory government the NHS would remain "free to all", but be reformed to make it more efficient.

He said patients did not care who provided the treatment as long as it was of good quality and, as a result, the voluntary and private sector should be allowed to compete, while NHS hospitals were given more autonomy.

Patient choice

The sentiments - while light on detail - echo many of Labour's reforms from patient choice to foundation trusts.

But the trend is not unique. Nigel Edwards, director of policy at the NHS Confederation, said it is part of a pattern seen across the world towards a market-driven approach to health.

"Healthcare models are converging in developed countries across, but it is leaving little choice for the public.

Conservative: NHS "free at the point of use"; rule out medical insurance schemes; have more private sector involvement in NHS
Labour: NHS "free to all"; patients able to choose any hospital, including some private by 2008; limit of private sector doing 15% of NHS work; waiting times to be down to 18 weeks
Lib Dems: Policy review under way. At election wanted to cut diagnostic waiting lists for tests; free long-term care for elderly

"They are centring on competition, diversity of supply and choice. This is what we are seeing."

However, one area where there was a hint things might differ under a Tory administration was use of the private sector.

Mr Cameron said he would not set a cap on private involvement, whereas Labour has said no more than 15% of non-emergency surgery would be carried out by the independent sector by 2008.

Government officials say the "cap" was imposed largely to keep backbenchers happy, although they do not feel there is insufficient demand to require any more private involvement.

Alan Maynard, professor of health economics at York University, said the way the two parties were approaching private sector involvement was concerning because firms would naturally "skim off" the easier operations such as cataract surgery and hip replacements to maximise profits and this could damage future doctor training.


But he said that did not mean that greater private involvement was not possible.

"You could have a privately provided, public service. The Dutch do it, but the thing is you need to have the regulatory framework in place.

"But neither the government nor the Tories are facing up to this."

Doctors leaders have also raised concerns.

Dr Sam Everington, deputy chairman of the British Medical Association, said medics would be worried about unlimited private sector involvement.

But he felt it was possible Mr Cameron may not end up going that far.

"He wants his party to be trusted on the NHS and I think what we are beginning to see - just as Gordon Brown stuck to Tory spending plans after 1997 - is a pledge to carry on with what Labour is doing on public services."

If that does happen it may be left to the Liberal Democrats to offer a different vision for the health service.

Traditionally, the Lib Dems have been much more luke warm about private health care provision.

They are currently undergoing a policy review, but in the past they have shied away from calling for an introduction of a market to the NHS, instead favouring more investment in expanding NHS resources.

And whereas the Tories and Labour are making much of patient choice and multiple providers, the Lib Dems preferred to campaign at the last election on giving free long-term care to the elderly.

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