Speech at the Liberal Democrats Autumn Conference 2017

Today at the Liberal Democrats' Autumn Conference 2017, I set out my vision for a liberal, modern and dynamic NHS and care system which treats everybody with dignity and compassion.  

The full text of the speech is below. Alternatively, you can watch it online here (skip to 2:52:32). 


On Saturday, I celebrated - if that is the right word - my 60th Birthday.

And here I have my first free prescription.

Yet today, I earn just the same as I earned last week.

How can you possibly justify this perk when an 18 year old with a long-term condition, like cystic fibrosis, has to pay for theirs?

Or when we see people being denied a hip replacement, or IVF treatment?

When a teenager can be left waiting a year for mental health treatment?

This ludicrous benefit for many people on high pay is yet one more powerful reason why we need a national conversation about how we guarantee the future of our NHS and our social care system.

I have been pressing the Government for the best part of two years to work with other parties to establish an NHS and Care Convention with the aim of delivering a new settlement.

We face difficult choices.

Partisan politics has failed to come up with solutions. 

So let's accept that and work together to deliver a once in a lifetime renewal of the NHS and our care system.

But this needs the Government to act.

Theresa May, we have waited long enough. Work with us.

Parties can go on hurling abuse at each other but it doesn't help an elderly person with dementia get the care they need.

I was proud that we were the only party at the last election to offer an ambitious, credible plan to give the NHS and social care additional resources - through a penny on income tax.

But this solves only one part of the problem.

That great Liberal, William Beveridge, recognised right back in the 1940's that the people of this country were being let down, that they deserved better.

So he proposed a National Health Service. His vision has served this country well.

And the fundamental principle of the NHS - that you get care, when you need it, regardless of your ability to pay - is as important now as it ever was.

It says something profound about who we are - a sense of solidarity, that we look out for one another.

But the health challenges of today are radically different to what Beveridge grappled with.

Again, today, 70 years on, families the length and breadth of this country are too often badly let down.

So many incredible people work in our NHS - totally dedicated to the care and treatment of patients.

Our brilliant doctors, nurses, midwives, physiotherapists, cleaners, porters.

But they are working under incredible pressure.

Take the paramedics I met with in Norfolk recently. They are deeply concerned about the impact on acutely ill patients of long delays. They frequently work horribly long shifts.

I don't know about you, but I think NHS staff deserve a proper pay rise.

And remember all those people from across the EU who help keep our NHS and care system going.

Guarantee to them NOW the right to stay, Mrs May.

As we approach the 70th Birthday of the NHS those brilliant staff work in a system that is too often fragmented, dysfunctional and starved of resources.

And we have to confront the fact that in many ways, we fall short.

The Commonwealth Fund has just ranked the NHS as the best healthcare system in the world - for the second time running. An amazing achievement.

But it also revealed some sobering truths. We were ranked just 10th out of 11 high-income countries on outcomes for patients. We compared poorly with other countries on survival rates for cancer, and had the third highest death rate among stroke patients.

On access to new medicines that could transform people's lives, Britain already lags behind other countries including many of our European neighbours.

And now, the NHS has introduced a cap on the overall cost of a new drug - allowing it to restrict access to a new treatment for cancer or a rare genetic disease, even if it has been approved as good value for money by the medicines watchdog, NICE.

And that’s just the tip of the iceberg when it comes to the disturbing advance of rationing in the NHS.

How many stories have we seen about restrictions on access to treatment and the removal of services, without any transparency or public debate?

And the 18 weeks to treatment target, shamefully abandoned.  

Many of you will know of my mission to achieve justice for those who experience mental ill health or who are autistic or have a learning disability.

As with so many people in this hall, I have been informed by family experience.

My own sister, Catherine, took her own life.

So I particularly want to speak about how the system lets down some of the most vulnerable people.

Across the country, children are routinely left waiting three years for an autism diagnosis - yet we know that early intervention can make a massive difference to a child's life chances.

I met with a tearful mother of a 14 year old boy who has just been told, one year after referral, that he is likely to get an autism diagnosis in two years. He will have left school by the time it arrives.

This is a scandalous failure.

In children's mental health services, long waits and outrageous thresholds for admission are common.

Teenagers with an eating disorder are too often turned away from treatment: 'Your Body Mass Index isn't low enough'.

Would we ever turn away someone with cancer and effectively tell them to come back when they are at death's door?

Remember, like cancer, eating disorders can kill.

A father in North Norfolk described to me how his teenage daughter with significant mental illness had been told that she would have to wait 6 to 9 months to start her treatment!

And then there are those who are shunted across the country because there is no care available close to home.

Things are so bad that a senior judge had to intervene in August to demand a bed be found for a teenage girl who was acutely ill and about to be released from youth custody.

The nation, he said, would have 'blood on its hands' if an NHS bed could not be found.

Additional funding secured by the Lib Dems in the last Coalition Budget - £1.25bn over five years – is not all being delivered.  In year 1, almost half of the money was diverted elsewhere. In year 2, half of local areas fell short of what they should have spent.

Shockingly, the Care Quality Commission reported in July that there are 3,500 beds in locked mental health rehabilitation wards - a contradiction in terms.

Often a long way from home. Institutionalised. Isolated from friends and family. This has to change. 

The CQC also highlighted the use of force to restrain patients.

Four years on from the guidance I issued as minister to end the use of face-down restraint, the practice still persists in far too many places.

My investigation last year revealed a staggering 12,347 cases of face-down restraint in a single year - 33 each day.

Imagine having suffered abuse earlier in your life and then experiencing the physical force of face down restraint in a mental health ward.

This can destroy trust and can be appallingly traumatic for the individual.

And yet inspiring, progressive practitioners in many places have pretty much eradicated this practice. So it can be done.

Take Fauzia. She was admitted to an independent hospital at the age of 15. Fauzia has autism.

Soon, her family became horrified by the treatment she was receiving. Repeated heavy use of restraint; often placed, on her own, in a small cell-like bare room.

They were desperate to get her out. But they were completely ignored. No one listened to them.

Eventually, Fauzia's aunt spoke to me. I took the unusual step, as minister, of deciding to visit Fauzia.

I was horrified by what I saw and heard. I initiated a review. We got her out, eventually. After two years.

Recently, I visited her again in a wonderful home. From the day she left, she had not been restrained on a single occasion. She was a totally transformed person. Talking constantly. Happy. She now has a good life.

But there are many other Fauzia's around the country – hidden away from public view, with no one fighting for them. It is a stain on this country's reputation.

Article 3 of the European Convention on Human Rights states that "No one shall be subjected to inhuman or degrading treatment". The uncomfortable truth is that in Britain in 2017, many people are.

And it is a scandal of our time that there are so many people in our prisons, who are there, in large part, because of their mental ill health. Yet their chances of proper care and treatment are not good.

There were a catastrophic 40,000 cases of self-harm in our prisons last year. Every three days, a life was lost to suicide.

My vision of a liberal society is one where we marry a celebration of great technological advances, a dynamic, successful country with rich culture, joyous entertainment with a commitment to justice, to compassion, and humanity, where no one is left behind, neglected or ignored.

We can do this. As we make our case for a 21st Century Beveridge Report we should think about how we apply our Liberal principles to the great endeavour of renewing our NHS and our care system.

Yes we must argue the case for more resources as I have consistently done.

But we should also think about how money is spent. How we achieve the best results for people. How we help to give people a happy life, a good life.

The following principles should guide us:

First, we need a big bold commitment to end the shameful and growing inequalities of health.

The causes of these inequalities mostly lie well beyond the NHS - poor housing, poverty, education.

But we can't continue to tolerate the fact that for every station on the Jubilee Line heading east from Westminster, a year of life expectancy is lost - and it's the same stark differences in every city.

Second, in any new settlement for the NHS there must be genuine equality for those who suffer from mental ill health. We have to bridge the gap between the rhetoric and the reality.

Third, we have an extraordinary workforce in the NHS and in social care.

But they too often feel disempowered, ignored, subject to repeated and often conflicting diktat from on high.

Too often it amounts to a bullying culture where brave whistleblowers are destroyed rather than treated as heroes for uncovering wrongdoing or poor care.

I want a Liberal vision - transforming the culture, unleashing brilliant social entrepreneurs, encouraging innovation.

Think about what that great Liberal, Jo Grimond, might have done. Let's apply the principles of mutualism to the NHS - giving people a stake in their organisations, a say in how their service is run.

Fourth, we need to make a fundamental shift of focus to prevention.

We now know that children who suffer trauma or neglect in early years have a higher risk of poor health, low educational attainment, worklessness and often fall into the criminal justice system.

We let these most vulnerable children down horribly. And it costs the state a fortune.

Yet we know that intervening before the trauma has set in, working with parents, we can transform lives - so let's do it. Make the big investment. It will pay off.

Equally, let's set a ten year plan to get employers really focused on the health and wellbeing of their workforce.

As part of my work chairing a Commission on mental health in the West Midlands, I've proposed a 'Wellbeing Premium' - a temporary discount on your business rates if you take tangible steps to improve wellbeing at work. The evidence is there of what works. So let's do it.

And should we not set a clear requirement that any company bidding for public contracts MUST demonstrate that they are a good employer, that they care for their workers? Why should we give work to corporate cowboys? 

Fifth, we should embrace the Manchester model of devolution – empowering local leaders and communities to shape a health and care system that works for them. 

Sixth, we must give people control of their health - access on their iPhone to their health records, helping them to self care, giving them control over the budget for managing chronic conditions. A distinctly liberal idea. 

Finally, we are on the brink of a complete revolution in healthcare. Emerging innovations in personalised healthcare, digital technologies and artificial intelligence have the potential to transform the way we can diagnose, treat, and prevent ill health.

Just look at precision medicine in cancer and rare diseases, targeting specific groups of patients based on their genetic data. 

And take sepsis, which kills 44,000 people a year in this country – equivalent to a jumbo jet crashing every three days. New advances in artificial intelligence offer hope of a major breakthrough in how we understand, identify and treat this condition. 

Yes there must be proper safeguards, but we should make the case for investment in technologies that have the potential to improve care, save lives and to significantly reduce cost.

I often hear young doctors talking about how they are losing confidence in the future of the NHS, demoralised, worn down by the strain of rota gaps, anxious about having to make impossible choices over which sick patients get treatment, a system under impossible pressure with no hope of anything changing.

We need to offer people - patients and staff - a new vision. A modern, efficient NHS and care system which gels the smartest innovations, the best use of resources with dignity, with compassion and with justice. That is our vision.

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