Every part of England has different healthcare needs. The demographics of each region can vary significantly, both in ethnicity and age. Any doctor will tell you that different social groups need different types of healthcare provision. Experience tells us that there is no ‘one size fits all’ system that will work for a country as diverse as England. Being a GP locum who works in both affluent and socially-deprived areas, I know too well that local clinical priorities need to reflect these differences. And this is the rub for the old Labour party. For those Socialists who aspire to deliver an ideologically-driven, uniform healthcare service are missing a key point: that it does not allow for human behaviour. With increasing local control over healthcare services becoming the political mantra, there will come regional differences in the provision of care. Local people will want local health services to suit them, not a set of centrally-imposed, national guidelines. In semi-rural communities, such as those served by the new Hexham hospital (pictured above), an older population will want a greater emphasis placed upon rehabilitation and elderly medicine. In contrast, an urban centre such as Slough, where I often work, would demand a proportionately greater spend on drug and alcohol addiction and those conditions more associated with the relatively large ethnic minority populations. So, yes there will be differences in healthcare provision throughout England. Detractors will call it a ‘postcode lottery’. Supporters, such as myself, will argue that until local people take ownership of their own individual health and play an active role in determining the health services offered locally, the health of the nation as a whole will not improve. For I believe that taking responsibility on every level is the key to good health. I already accept that if I am selected as a Parliamentary candidate, one of my many responsibilities would be to campaign hard to deliver and protect those healthcare services most needed by the community I represented. My impression is that it will not be long before we are all referring to our LHS (Local Health Service) not the NHS.

There is an irony in a fat government advocating more government to help fat people be less fat. In the same way that I believe that less government is often good government, I also believe that more personal responsibility and less state responsibility will lead to less fat people. There are undeniably many components to why someone becomes fat, however, one of them is personal choice. I have philosophical problems with the state telling an individual that he has made a ‘poor’ choice in becoming fat. If that individual has made an informed choice to eat more than he needs, and let us all admit that most people who are obese have done just that, then that person should be allowed to make that choice without fear of castigation by the state. He should, however, in making that choice, be made to pay for his decision. For being obese has profound cost implications for the state. Not only are there increased costs in health, there also long-term expenditure implications for the social security budget. Nor should we forget the implications for the individual and any of his dependents.

If I was in government I would look at the increasing obesity epidemic and ask myself what could the state do to increase personal responsibility. Levying a fat tax on food has been suggested, maybe even an additional supplementary tax based upon BMI (body mass index) could be pursued. These policies might go some way to reducing a future of obesity for our children. For the present, however, a decision must be made to invest in treatments that work.

The aetiology of obesity can often be complex. The provision of medication to aid weight loss (and in extreme cases surgery) should always go hand-in-hand with a proven commitment on behalf of the individual seeking treatment. Furthermore, many psychological factors are known to contribute to an individual’s excessive weight problem, so the involvement of properly-funded psychiatric services should be part of any programme to reduce obesity. The ultimate solution to the problem rests, however, with each obese individual. No government of whatever hue can change that reality. It may be tough politics, but dealing with obesity is a tough problem that will involve tough and unpopular decisions.

What did I do that was so evil that I’m trapped in this awful place….? – Joseph Nixon

The disgraceful account of Joseph Nixon’s last few days stay in Maidstone Hospital has highlighted the on-going problems within the NHS. The 87 year-old Dunkirk veteran and former Coldstream Guard had contracted a Clostridium difficile infection during his hospital stay and died recently. Jackie Nixon, his daughter, reported that she “ended up having to change (his) bed for him the whole time because otherwise he would be left lying in his own soiled sheets for three to four hours at a time…”. His case vividly illustrates that the standard of delivery of healthcare in this country is far from acceptable.

Clostridium difficile (C Diff) is undeniably a difficult infection to treat. The bacterial infection does not harm otherwise healthy people, however, problems occur when very poorly patients on hospital wards are treated with antibiotics. C Diff can then overwhelm other ‘competitor’ bacteria in the gut leading to profuse diarrhoea, and in worse case scenarios, death through intestinal perforation and septicaemia. Not surprisingly, the elderly are most at risk, with over 80% of reported cases being found in people over the age of 65. Although a challenge to treat, simple procedures such as washing hands between cases and isolation of the patient can help to prevent the infection spreading around the hospital ward. And here is the crux of the problem. To prevent such spread a hospital would ideally have access to isolation wards, the capacity to provide individual nursing and a fully-staffed infectious control clinical team. All of that costs money, and lots of it.

Since 2002, public spending on healthcare in this country has doubled. On Tuesday, the Chancellor announced that NHS funding by 2010 will be £110 billion per year, i.e. the NHS will be spending £3500 per second. I suspect that the ‘average person in the street’ would think that a doubling of expenditure to that level would lead to a better service. By better, I would expect they mean shorter waiting times for GP and hospital appointments, better working conditions for staff and, above all, a cleaner and friendlier hospital environment to be treated in. Unfortunately, the tragic reports today provide further evidence to suggest otherwise. The scandal surrounding Maidstone Hospital has dispelled any claim that the large increase in funds provided by the British public has been well-spent by this increasingly discredited government.

This Labour administration’s obsession with top-down targets and their mistaken belief that the problems within the NHS were simply due to underfunding ,have been shown to have been disgracefully naive judgements. Decisions, such as the on-going, appalling overspend on the Patient Records Project (PRP), have led to financial shortages for front-line staff. The PRP is the most expensive IT project in the world, and I, and many of my medical colleagues, fail to see how the estimated £15 billion pounds budget (latest est. and rising) can ever be good value for money, particularly in a system so starved of funds on the front-line. Why choose to spend so much money on an IT project not deemed a priority by the medical profession? What of the £500 million (and rising) spent on management consultancy fees? What about the unfairness of spending more money per head on health in Scotland than in England? Why are there now more managers in the NHS than medical staff? Why did the Labour government spend all of our money before reforming the system? However, the key question for the Prime Minister from any tax-payer would be the following – If Mr Nixon, a distinguished war veteran, can be so badly treated, where has all the money gone Mr Brown?

Too many questions and yet not enough answers. This government is so bereft of the insight and ability required to manage such an important public service that getting answers will be next to impossible. The Conservative Party has a moral duty to continue to oppose this useless administration, so that the NHS can be properly reformed. By doing so, it will go some way to preventing the tragic case of Mr Nixon being repeated in the future.

On Tuesday afternoon I spoke in the Conference Hall about how Conservatives would care for drug addicts and thereby reduce crime. I said the following:

GOOD AFTERNOON LADIES AND GENTLEMEN.

ONE OF THE MANY REASONS I JOINED THE CONSERVATIVE PARTY IN 1992 WAS BECAUSE I BELIEVED THAT GOOD GOVERNMENT SHOULD BE ABOUT HELPING INDIVIDUALS WHO SEEK TO HELP THEMSELVES. SHORTLY AFTER DAVID CAMERON BECAME OUR LEADER, HE ANNOUNCED HIS INTENTION TO INCREASE THE NUMBER OF PLACES FOR DRUG ADDICTION TREATMENT. HE WAS RIGHT TO DO SO. ADDICTION AFFECTS MANY FAMILIES, BE IT ADDICTIONS TO DRINK, DRUGS OR GAMBLING.

I AM A DOCTOR WORKING WITH DRUG ADDICTS AND HENCE HAVE SEEN FIRST-HAND THE TRAGIC CONSEQUENCES OF DRUG ADDICTION. IT WAS WHILST CARING FOR THESE SOCIALLY-DISADVANTAGED PEOPLE THAT I CAME ACROSS THIS DOCUMENT. THIS IS A LIST OF “TEST ON ARREST” OFFENCES, FROM THEFT AND BURGLARY THROUGH TO FRAUD. IF SOMEONE COMMITS ONE OF THESE CRIMES HE/SHE IS AUTOMATICALLY GIVEN A DRUGS TEST. MORE IMPORTANTLY FOR THE OFFENDER, HOWEVER, IT LEADS TO ADDICTION TREATMENT WITHIN 48 HOURS. IF, HOWEVER, A DRUG ADDICT HONESTLY AND INDEPENDENTLY SEEKS TREATMENT FOR THEIR PROBLEM, THEY HAVE TO WAIT 2 WEEKS. SO, WHAT DO YOU THINK HAPPENS? CRIMES ARE COMMITTED TO QUALIFY FOR IMMEDIATE TREATMENT.

WHEN THE CONSERVATIVE PARTY GETS INTO POWER NEXT MONTH, IT SHOULD REMOVE THIS INCENTIVE TO COMMIT CRIME AND PROMISE TO PROVIDE MORE DRUG TREATMENT PLACES. BY DOING SO, IT WOULD REDUCE CRIME AND IMPROVE THE LOT OF SOME OF THE MOST VULNERABLE IN OUR SOCIETY. IN SHORT, IT WOULD BE A POLICY THAT IS TOUGH ON CRIME AND COMPASSIONATE ABOUT THOSE WHO ARE TRAPPED IN THE VICIOUS SPIRAL OF DRUG ADDICTION. IT WOULD BE AN EXAMPLE OF PROPER SOCIAL JUSTICE IN ACTION.

Overall, survival for all cancers combined in the UK as a whole is not only below the national average, it is also noticeably similar to some eastern European countries that spend less than one third of the UK’s per capita healthcare budget – The Lancet Oncology Journal

In 1979, the Conservative Party came to power to cure the ’sick man of Europe’. The unchecked powers of the Unions, most ably assisted by the Socialist Labour Party, had ravaged the British economy. Britain was sick and decrepit. Malaise, inflexibility and economic low self-esteem were widely reported. It took the Conservatives to administer the medicine, a not always pleasant experience for some, but as history has shown us all, a necessary economic tonic for Britain as a whole.

Yesterday, evidence was presented that confirmed that Britain is once more the sick man of Europe (see table above). Despite record increases in NHS expenditure since Labour came to power, British cancer mortality rates still rank amongst the lowest in Europe. The Lancet Oncology Journal claimed, on the basis of their figures, that the government’s cancer plan introduced in 2000 in England (2001 in Scotland) was not working. Cancer charities have since cited the absence of proper radiotherapy services as a major cause of poor survival rates. Tellingly, the report called for a “fundamental assessment of the ways in which the NHS operates”.

So, in summary, despite record investment, much legislation, the employment of more doctors and nurses, the reorganisation of primary care administration (three times), the introduction of private funding via the PFI initiatives (often leading to budget overspend), the appointment of a ‘Cancer Tsar’ and the contracting of a vast array of management consultants at large cost, this ten year-old Labour government has failed to put Britain on a par with the health of the rest of Europe. What a total disgrace. Furthermore, at a time when they have failed our cancer patients, they have embarked upon a hospital closure campaign that will adversely affect healthcare services. And yet, they still continue to tax us more and more.

Once more it would appear that it falls to the Conservative Party to administer the necessary medicine. It will not be an easy task. Confronting the entrenched interests that blight the NHS, dealing with the learned helplessness of the medical staff, eradicating poor clinical practice, emphasising services that are evidence-based as opposed to those “that we have always provided”, removing unnecessary management, localising decision-making, and most importantly, diminishing the power of the Department of Health, are goals that will not be easily achieved. We must, however, be determined to do so. For if we are successful, Britain will be bequeathed a health service that is fit for a First World nation in the 21st century.