Conservative leader David Cameron told delegates at the NHS Confederation conference in London last week that his party is after National Health Service evolution, not revolution.

Cameron’s speech to delegates at the conference came hot on the heels of the launch of the Tory’s white paper NHS Autonomy and Accountability, which had been unwrapped by Shadow Health Secretary Andrew Lansley just the day before.

In a nutshell, the plans include handing over day-to-day control of the Service to an independent board, as favoured by the British Medical Association, and placing budgets firmly in the hands of GPs, allowing them to make the decisions how the money is best spent in their practices and, thereby, increasing accountability.

Speaking at conference, Cameron reiterated that improving the NHS is his “number one aim,” and claimed that his party’s reforms are “designed to ensure that the money that we put into the NHS goes on improving the health service for everyone, and isn't wasted on the bureaucracy of politically-inspired targets and central instructions.”

All change

He went on to concede that change is necessary for the NHS to progress, but stressed that this change should be "coherent and purposeful, not disruptive and confusing.”

Accusing the Labour government of first scrapping reforms of the previous 10 years when they came into power back in 1997 and now, 10 years on, “slowly and painfully trying to get back closer to the system they inherited,” he said it is a “tremendous shame that NHS staff and patients have had to undergo ten years of upheavals,” and promised to stay away from “further unnecessary reorganisation.”

Outlining his vision for NHS reform, Cameron listed four progressive stages which he wants to see in place: “committing increasing resources to the NHS; devolving power and responsibility to the front-line; setting the NHS free from political interference in day-to-day management; and the transformation of the Department of Health into the Department of Public Health.

Explaining his plans for the DH, he said that when professionals and patients are in charge and the independence of the NHS is guaranteed then the role of the Department of Health need to change. “Nye Bevan [late Labour politician who brought in the NHS] wanted to hear the sound of dropped bed-pans echoing all the way to Whitehall. Andrew Lansley doesn't. He wants to know that the NHS has the money it needs, and that it is delivering rising standards of care across the health spectrum. Most of all, Andrew Lansley wants to be responsible for public health.”

The Tory leader also put his weight behind an internal market with the Service, saying that, although not perfect, the principle behind dividing NHS staff into purchasers and providers “is now almost universally accepted.”

Crocodile tears?

Reaction to the proposals has been expectedly mixed. Dr Dill Morgan, chief executive of the NHS Confederation, was pleased that the Tory’s plans shyed away from any significant change of direction and stressed the need for a period of stability. But Dave Prentis, leader of the UK’s largest health union UNISON, described them as a “backward” and divisive step.

“The Tories clearly have not learnt the lessons of the past; namely that splitting up our NHS and wasting money on creating bureaucratic, artificial markets does nothing but take our NHS backwards. Public services should co-operate with one another, not compete with one another.”

He also pointed out that Cameron was “the chief architect of the Tory manifesto which proposed cuts to public services at the general election just two years ago. His party also continues to advocate the privatisation of health services. No wonder health workers this week viewed his latest speech as little but crocodile tears.”