The choice is yours

Well, there are two things: peoples’ opinions are formed by their experience and there’s no doubt that people locally see themselves and their friends getting quicker access to doctors, shorter waiting lists, new hospitals and equipment. Their sense of optimism about the future is very high. There is, however, a pessimism that seems to beset people when they are asked about the service nationally. This is largely – although not exclusively – the result of the way the media portrays the health service.

We are doing three things to change the health service. First, we are increasing the capacity, by investment and reform – more doctors, nurses, hospitals, equipment and so on. That means that people are getting a better service in greater volume. Second, we have now started to give people better quality. What that means is giving people more information and choice – essentially more control – over their own healthcare. Third, we are helping people to prevent illness themselves. So, as we proceed in all three of these, we will see an increasing perception among people that the NHS is getting better.

Access to the health service has for 60 years been built around the convenience of the providers. When your doctor tells you that you need to see a consultant, he hasn’t in the past talked you through where you might go, how quickly you might get in at various hospitals other than your local one, and booked it online there and then at a date convenient to you. Now that will start next year. But that small step for mankind is a huge revelation for the National Health Service.

And it is precisely because we haven’t had personalised healthcare in this country that the massive advances of the National Health Service have nevertheless been accompanied by increasing inequality among some groups. A child born into a working-class family in Manchester tomorrow – tomorrow – will have a life expectancy of nine years less than a child born into a middle-class family in Dorset. The confusion of equity of access with uniformity and with identity has been one of the biggest mistakes among certain sections of the left. And we can see the results in front of us. Everyone has got a bit better off, but a lot of people from wealthier backgrounds got better off than others.

The proposals are significant because people in the National Health Service have never been given choice. We have given a mother with two or three kids, one of whom gets ill at night, the choice between picking up the phone to NHS Direct, or going to a new walk-in centre, or to go to an A&E and actually get seen within a short period of time, or to see the nurse practitioner if the doctor is not immediately available.

These are simple steps – but with huge benefits. Women now have the choice of a midwife-led birth rather than a consultant-led birth. Someone who’s had the same prescription for twenty years has the choice of going and getting it at the chemist rather than having to wait for doctors’ appointments. All these things are common sense.

The difference between our choice and the Tory choice is this: the Tories have always spoken about theoretical choice. They’ve always said that everyone is free to dine at the Ritz, everybody’s free to buy their care. Though, of course, not everybody can, because they don’t have the money. Or, at least, most don’t. And if you don’t have the capacity, the resources and the money, choice remains theoretical.

That is why with the new money we are putting into the health service we can make choice a reality. And the more capacity we put in, the more choice there will be. Which is why by 2008, if you don’t want to choose from one of five hospitals given by your primary care trust you can choose any hospital in England – private, charitable, national health trust – always provided they meet NHS standards and the NHS price, and it will be illegal for any of them to try and charge a supplement. The Tories, on the other hand, will take the capacity out of the health service, they will allow the waiting lists to drift up again, as they make reductions, and then they’ll say you can have choice but you’ll have to meet half of the cost of your own operation.

I want to take the state off people’s backs and put it beneath their feet. If we don’t build public services around the individual then over the next 60 years, as people get better off, they will go and buy quality, convenience and personal power elsewhere. That would be a tragedy, as eventually it would leave the NHS as the repository only of the poor, and I want to avoid that at all costs. It is part of a much wider challenge to the left – of how you reapply collective values in an age of consumerism and individualism. The essence of the struggle of the Labour movement for the last hundred years has been to convert the theoretical choice that working people have but could never exercise – the right to buy things – into a real choice.

First of all, it’s not won. This election – like every election – is capable of being won by any party and it would be utterly foolish for the slightest hint of complacency to inform any of our actions. Every single one of us has an obligation to the collective unity of this party and to fight for every single vote that’s out there. Why is it important to do that? Because even after seven years we have only just begun to effect the sort of changes that we would want to see in Britain.

We have got 100,000 more doctors and nurses but we need a lot more. The first term was about economic stability and social justice for all people. The second one has been about beginning the reform of public services and putting in the capacity and the resources that came from an improvement in stability in the first term. And in the third term, we are seeking to redesign public services so that the state becomes a vehicle for assisting individuals to shape their own lives.

The Tories were successful because they were a non-ideological party. But Mrs Thatcher refashioned the Conservatives into a dogmatic, ideological party. We have been lucky that they have been so slow to recognise the need to renew themselves.

The other reason is that Labour has captured the centre ground – so we would be mad to leave it. We would be damn foolish if we were to become ossified or dogmatic, but also if we were to forget that the substance of new Labour is much more important than the spin. The organisation and the new public relations were important, but the essence of new Labour was that nothing would appear and be relevant to modern people who decide this election unless it was shaped in terms of, and made sense in, the changing modern world.

We ended up with economic stability and social justice. In stressing rights and responsibilities, recognising that the production of commodities and services is the fountain from which resources come to be distributed towards the public services, but that these are not opposites and are in fact in synthesis, we recognise that. If we were mad enough to lose that then there would be a vacuum there, which, eventually, the Tories might be able to occupy.