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Michael Howard has promised a radical shake-up in health and education, placing choice at the heart of his new poli...
Michael Howard has promised a radical shake-up in health and education, placing choice at the heart of his new policy agenda, and pledging billions of pounds in additional resources for schools and hospitals.

Delivering a keynote speech in London yesterday, the Conservative leader outlined a broad strategy offering an entirely fresh approach to front line public services, replacing Labour's obsession with centralised control with more power for parents and patients, based on the right to choose the schools and hospitals they want to use.

Pledging to liberate services by giving heads and hospital managers more freedom to run their institutions, he likened his proposals to Margaret Thatcher's highly successful scheme to give tenants the right to buy their council homes. And warning that Labour's outmoded 'command and control' approach has failed to achieve the standard and delivery improvements 'a first class nation like ours deserves', Mr Howard said:

'We must let parents and patients choose what they believe is best for them and their children. It means ending the command and control political consensus on public services that has persisted for far too long, but failed to deliver. It means trusting parents and patients to make decisions - not forcing them to take what they are given.'

The switch will be backed by higher funding, which by the fifth year of a Conservative government would mean£49bn a year on the NHS and schools, on top of the spending plans inherited from Labour - including an extra£34bn a year on the NHS and£15bn annually for schools.

Mr Howard's speech triggers the second stage of the party's general election strategy, and the beginning of a series of announcements to rollout a more detailed policy agenda for public service reform.

During the address, he attacked Labour's poor record over the past seven years, when the huge expectations raised by Tony Blair's election promises were left unfulfilled - despite huge rises in tax levies, and massive increases in state spending.

'The reality is that Labour have spent without real reform. That is also Labour's tragedy. It is also the country's tragedy,' Mr Howard said.

Full speech follows:

Michael Howard - The right to choose: How to deliver first class health care and education

Speaking at the Institution of Civil Engineers, Conservative Party leader, Michael Howard, said:

Check Against Delivery

'Two years ago I came back into front-line politics because I was angry about the state of healthcare in this country. In my constituency in Kent, I saw people growing more and more frustrated with a system that was letting them down.

Yet just twenty miles away across the Channel, in France, people had routine access to a quality of healthcare we don't think is possible in Britain: a publicly funded system, which puts the patient first and which has no waiting lists. That's right. No waiting lists.

I didn't accept then - and I don't accept now - that we have to put up with second best here in Britain. We are a great country. We can do better - much, much better.

The Problem

In Britain we have significantly lower survival rates for cancer, heart disease and strokes. We still have almost a million people on waiting lists. The elderly wait months for hip replacements. None of this is right and none of it is necessary.

The same goes for our education system. One in three British children leave primary school unable to read or write properly or to perform basic arithmetic. A third of 14 year-olds don't reach the required standard in Maths, English and Science. Our universities have to run remedial classes in writing.

Labour's Approach: First, Greater Centralisation

How, you might ask, did we get to this point? Think back to Tony Blair's first election victory. People thought that 1997 was going to achieve for the public services what 1979 had achieved for the economy - a complete transformation.

Just as Britain's economy had been turned round by the reforms of the 1980s, so people hoped Britain's public services would be turned round by New Labour and Tony Blair. Britain would have, Tony Blair pledged, world-class public services. And people believed him.

Labour promised real reform - not just more money. In fact their 1997 Manifesto was quite clear about this. It said bluntly that ' the level of public spending is no longer the best measure of the effectiveness of government action in the public interest'.

1997 was a moment of huge promise. But as we all know rhetoric is one thing; reality quite another.

The most striking thing about the Blair Government is not that it introduced real reform of our public services, but that it simply stuck to the old fashioned approach of greater centralisation: an approach which the Conservative Government had at last begun to challenge.

Labour abolished Grant Maintained schools and put them back under political control. In health, Labour abolished the internal market, which Ken Clarke had introduced in 1988. As the OECD has found, this meant that the substantial gains in output which Conservative reforms had delivered in the early 1990s were lost.

Centralisation failed to deliver the results Labour had hoped for. But that is hardly surprising. We learnt that lesson with the economy in the 1960s and 1970s. In Britain, after the war, there was a consensus that the British economy should be run by command and control.

Government ministers intervened to decide the prices in the shops; to control how much money people could take on holiday; and to run our major industries.

As a result Britain became the sick man of Europe. Our living standards fell behind. Public services suffered.

So why did we cling for so long to a big government approach to the economy that clearly wasn't working? Well because for a long time it was the consensus of the political elite.

That changed in 1979 when a Conservative Government ended Britain's post-war economic consensus. From the sick man of Europe, our economy became the powerhouse of Europe.

That transformation was based on a fundamental truth - politicians shouldn't micro-manage the economy. We learned in the 1980s that the role of politicians is to set the framework which allows others to do what they do best: win orders; develop new products; serve the customer; create jobs; and generate the nation's wealth.

We learnt, in effect, that the State should be smaller so that people could be bigger. It is a lesson Labour have failed to learn in our public services.

Labour's Approach: Second, Higher Public Spending

When command and control did not deliver the results Labour had hoped for, they resorted to dramatic spending increases.

Since Labour came to office, spending on the NHS has increased by almost 50% and spending on education and training has increased by almost 40%.

But while there have been some improvements, there have not been nearly enough. As the OECD has made clear the NHS 'increases in output lag far behind increases in input'. In healthcare, Britain is now spending above European levels - but we are not getting anything like European levels of care.

And Labour's command and control approach to our public services has left hard working teachers, doctors and nurses demoralised and undervalued. They have become human instruments of ministerial will. The public sector is now subject to such all embracing central control that it diminishes those who work in it.

So having started by arguing that our public services needed real reform, Labour now claim that it's all about money. Once all the funding has filtered through the system, they argue, things really will start to improve. But the first lesson of economics is the law of diminishing returns, which applies to the public services in the absence of reform. It should be the first billion pounds of extra spending which makes the biggest difference, not the last.

The reality is that Labour have spent without real reform. That is Labour's tragedy. It is also the country's tragedy.

Public Services are Highly Individual Services

We talk about healthcare and education being public services. But healthcare and education are much more than just public services; they are highly individual services and should be delivered as such. And the dedicated people working in these services are all individuals - though they have a common motivation: personal care.

Every child is unique. Each has different aptitudes, needs and interests. A uniform, centralised system of education cannot cater for their many individual needs. And when Whitehall tells teachers exactly how to do their jobs, many of the best teachers will leave - extinguishing the spark at the heart of good teaching.

Even more than education, healthcare is by its very nature intensely personal. It is intimate and specific to the individual. Provision of healthcare should be on the basis of individual need.

A New Approach

It is clear then that a new approach is needed, an approach that will work and that will turn our outdated public services into the personal services of the 21st century.

Between now and the election, we'll hear lots of partial claims of success from the Government. Some of them may be justified. But ministers are deluding themselves if they believe that overall health and education have been transformed - or indeed are capable of being transformed - by more ministerial diktats from Whitehall.

It took Winston Churchill five years to win the Second World War. It took Clement Attlee six years to build the post-war Welfare State. Seven years is more than long enough for Tony Blair and his Chancellor Gordon Brown. Their approach has been tried. And it has failed.

We need a new approach. We need the Right to Choose.

The Right to Choose

We must transform the Government's role from being a monopoly producer and manager of healthcare and education, to one where it guarantees and funds everyone's Right to Choose.

We must let parents and patients choose what they believe is best for them and their children. This is a very big change.

It means ending the command and control political consensus on public services that has persisted for far too long, but failed to deliver.

It means trusting parents and patients to make decisions - not forcing them to take what they are given.

It means giving real power to real people - not leaving the man in Whitehall to decide what is best.

It is true that in politics there are no easy answers. But sometimes there are simple ones. And my simple idea is the Right to Choose. I want to give everyone the kind of choice in health and education that today only people with money can buy.

In the 1980s we gave new rights to council tenants. The Conservative Right to Buy policy gave council tenants the kind of choice which at that time only people with money were able to exercise. The Right to Buy meant they no longer had to shut up and take what they were given. It gave them control over one of the most important parts of their lives - their home.

The policies on health and education which we will be announcing over the next month do not require payment. In that respect they differ from the Right to Buy. But the benefits they will deliver will be even more far reaching. They will build on the passports policy originally set out last year. But they are more ambitious.

So we have renamed them the Right to Choose. And what we say is what people will get.

The Right to Choose is intrinsic to human dignity. In much of their lives, people's needs and expectations are framed by their ability to choose and so exercise control over their destiny.

Giving people the Right to Choose goes with the grain of human nature. It liberates the human spirit. People want to make their own choices. They like to have control over the services they use.

Today's empowered consumer expects to be able to exercise choice. Yet our healthcare and education systems reflect the assumptions of the immediate post-war era when resources were limited and rationed.

We're not living in 1945 any more. A system that denies people choice over some of the most important aspects of their and their children's lives is out of tune with the times. It needs to change.

Some people want to cling on to the old ways - the command and control political consensus of the last 50 years. Gordon Brown is one of them. In a lecture last year to the CASS Business School, he said that in health, 'the consumer is not sovereign'.

Let me repeat that. Gordon Brown said that in health 'the consumer is not sovereign'.

In other words people cannot be trusted to make decisions for themselves and their families when it comes to health care. But that is simply not true.

Choice works. It transfers accountability from politicians to patients and parents - those with the single greatest stake in the outcome. Doctors, nurses, teachers and everyone else employed in the healthcare and schools systems will no longer work for politicians, but for patients and parents.

They may be demanding - but that's because they want the best for themselves and their families. And it is far more rewarding to work for them than for interfering politicians.

The Right to Choose is not about removing government involvement - but simply about changing what government does.

Government is transformed from being a monopoly producer and manager of healthcare and education, to one where it guarantees and funds everyone's Right to Choose. Monopoly is always the enemy of high standards.

Half the hospitals in Germany are in the private sector, but open to patients whose treatment is funded by the taxpayer.

Seven out of ten children in the Netherlands go to schools funded by the State, but not run by the State.

Even in socialist Sweden, parents' right to choose has led to a huge increase in non-state run schools. All these systems produce much better results than we get here in Britain

When you look at the performance of the NHS and the education system now, both fail the poorest and most frail members of our society.

The better off get access for their children to the best state schools by paying more to buy a house in their catchment areas - or they can opt out of the system altogether.

The Wanless Report on the NHS found that poorer patients received less effective treatment than those in middle class or affluent areas.[1]

According to Alan Milburn, 'in fifty years health inequalities have widened not narrowed.'[2]

The myth that state provision means the interests of the least-well off in society are protected is just that. A myth that has kept our health and education systems trapped in a time warp.

It is a myth that hurts the least well off most.

It is a myth that means most people receive services that simply would not be tolerated in other countries.

It is time we nailed that myth and ended the shocking inequalities between the rich and the poor in standards of treatment in health and education.

It is time to raise standards by giving everyone the Right to Choose.

And it is time to end a world where people have to shut up and take what they are given.


The defining feature of the NHS is its waiting lists.

No similar country in the world has one million people on waiting lists.

For all the extra billions going into the NHS, waiting lists remain part of the Government's vision for the NHS.

Under the Government's plans, by 2008 they will not have eliminated waiting lists, but only aim to have reduced them - and we know what the reality of that involves. Managing waiting lists to hit political targets is not a substitute for designing waiting lists out of the system altogether.

We can learn from those countries - and aim for a healthcare system that is even better than theirs.

I am constantly amazed that when comparisons are made with healthcare systems abroad, ministers go on the radio to point out what's wrong with those countries.

But they ignore the fact that continental systems deliver much higher quality healthcare to their people than we get from the NHS. There isn't a healthcare system in the world that doesn't have its own problems. But the starting point for us in the UK is to recognise that we could do much, much better.

So let me set out my objectives for a modern healthcare system.

At its heart must be accountability to the individual patient. That is to say, in our system the consumer will be sovereign. The money will follow the patient's choice, rather than the patient being told where he or she has to go.

Second, there will be guaranteed free access to comprehensive healthcare for all. The system must respond to individual patient need and not, as happens currently, put people on a waiting list and tell them to wait until the system is ready for them. It defines the absolute core role of government - to fund access.

Third, there will be incentives for efficiency, quality and value for money. I make no apologies for the importance of efficiency. The more efficient a healthcare system is, the more operations and treatments we will have and the more healthcare we will get. The healthcare system must be financially sustainable and the best way of achieving this is to embed the right incentives in the system.

Fourth, we will minimise the scope for future political interventions. Once the big changes have been made, the politicians should move aside and let patients choose and the professionals deliver.

You know and I know how the Labour scare machine responds to any Conservative proposal to improve healthcare by trying to frighten people off from having a better future. And you can be sure that it will happen again and again, their tactics getting more extreme and shrill as we get closer to the election. They will unleash a firestorm. But I utterly reject the idea that the Labour Party owns the freehold of the debate on this issue.


In schools, it is now widely accepted that a centralised, top down approach does not work.

I think this was even recognised by the Government when it said in its 2001 Schools White Paper that it wanted a school system that 'embraces diversity and autonomy'.[3] As so often, the language seems to recognise the problem. And as so often, the reality does not match the rhetoric.

But it should be self-evident that a centralised, top down approach cannot deliver this outcome.

Discipline, standards, character, care and the ambition to do one's best can only come from within a school and the head teacher's leadership.

They cannot be imposed from the outside. If the plethora of inspections, standardised teaching, testing, performance targets and all the other paraphernalia of centralised control were going to deliver, they would have delivered by now.

They must be drastically reduced, to give teachers room to breathe.

Every parent knows the moment they walk into a school if it is one they want their child to go to. The way pupils are dressed and whether you are made to feel welcome as a visitor. How teachers and pupils talk to each other. The sense of purpose. You can always tell.

So we need to swap the instruments of central control and inspection for genuine parental choice and the freedom for head teachers to lead their schools.

When other countries have made this exchange, the results have far exceeded expectations. Since school choice was introduced in Sweden in 1992 the result has been a flowering of innovation and educational attainment. The number of independent schools has risen from 90 to over 400. One new chain of independent schools now offers not only a personalised curriculum for each child, based on their progress and style of learning, but a personalised timetable.

There is no way this kind of innovation would have happened if Sweden had not given parents the Right to Choose. Ministers now talk about diversity and personalised learning. But they doggedly cling to a failed system which denies parents real choice - the only mechanism that can truly raise standards and generate diversity.

Experience shows that the Right to Choose leads to more schools, better schools, smaller schools, more diverse schools that cater for all parts of the community and all ranges of ability.

The struggle parents have to get their child into a good school - moving house, bargaining their way through the admissions rules - will be, over time, thing of the past. Instead schools will be striving for the right to educate your child.

Phoney Arguments Against Choice

Whenever change is needed because the present is failing, the dinosaurs of the past bellow their warnings.

I've heard any number of arguments against choice.

They tell us choice won't work. But it is the current system which is not working. Choice is not a leap in the dark. It is about learning from what works best in other countries and intelligently applying it in Britain. The Right to Choose is the way to raise standards for all.

They tell us choice is unfair. But it is the current system that is unfair, giving the disadvantaged the worst education and poorest health care. The Right to Choose gives the least well off the dignity that money buys the well off - the ability to decide for themselves - on exactly the same basis as the rest of society.

They tell us people don't want choice. But what people want is higher standards. The best way of getting a good local school is by having two local schools both wanting to educate your children.

They tell us choice is too complicated for some people. But if patients aren't sovereign, who is? The right to choose means having your GP working for you, not for a politician and a stack of Whitehall targets.

In reality all the arguments against choice boil down to this: the belief that people can't be trusted and that big government knows best.

Well I am more than happy to let the people decide whether they want to have the Right to Choose.

And the case that I will make from now until the General Election is this - it's not a question of whether we can risk change, but whether we can afford not to.

Can we afford to let down future generations of children?

Can we afford to lose loved who would be alive today if they had been treated in Europe?

Can we as a country afford the growing cost of failure?

And I know what their answer will be.

Conservatives will invest to reform. We will invest an extra£34 billion a year in the NHS, and an extra£15 billion a year in schools over the next Parliament. That is a total of an extra£49 billion a year in schools and hospitals.

I stress: this is investment to reform. It is not spend and waste, as we have seen under this Government and, I dare say, to a lesser degree under Conservative governments.

The Right to Choose and money to invest will transform our system.

In the weeks ahead, we will set out our Right to Choose plans in detail.


But let me end with a final, simple point.

The Conservative Government will bring a new approach to our public services.

Our ambition is to give everyone the kind of choice in health and education that today only people with money can buy.

We will give parents and patients the Right to Choose because that is the only way to deliver first class standards in health and education.

We will invest more to achieve that reform - investment to the tune of an extra£49 billion a year in health and schools.

And we will trust people, not politicians, to decide what is best for them and their families. Politicians will set the framework but people will decide - parents, patients, teachers, doctors and nurses.

That is a powerful message, a simple purpose, a Conservative belief. And it is an idea whose time has come. Thank you.'


[1] paras 9.57 & 9.60 Wanless interim report

[2] 11th February 2003

[3] para 1.5, Schools achieving success, 2001

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