Fast approaching its 60th birthday, the NHS is at a crossroads.

We have seen 10 years of heavy investment under Labour – desperately needed after years of chronic Conservative neglect. However, the money came with a merry go round of reform, throwing the service into disarray as staff and patients struggled to cope with constant restructuring.

So, although spending on health has now hit the European average, cancer and stroke survival rates in the UK are still poor compared to much of Europe, while health inequalities have actually widened under Labour. The diagnosis is clear: the centralised state has poorly served the worst off, the very people who need help most of all.

The Tories solution is to reduce accountability even further by creating an unelected quango to control our health service, which would ultimately have the power to close local hospitals. And should we ever really trust the Conservatives to maintain funding for health and social care – particularly given that the priority they chose at their conference last October was a massive cut in inheritance tax for million pound estates?

What we need is a radical culture change in our NHS, based on the principles of empowerment of local communities and of patients, fairness and quality. We need a liberal solution, which helps the most disadvantaged in society by giving each person the same entitlements – regardless of their income.

To make our health and social care services fair, I want to reduce the enormous burden suffered by many older people paying for their care, by spending £2 billion on a personal care payment for all elderly people requiring care, based on need and not their ability to pay. We must end the current pernicious system of means-testing. Our proposals have been welcomed by Age Concern, Help the Aged, Joseph Rowntree and the Kings Fund.

A ‘patient contract’ would replace top down targets with a guarantee of access to high quality treatments in core areas. Crucially, it would use the private sector to improve delivery by giving everyone the right to receive private treatment, paid for by the NHS, if the maximum waiting time is not met. In Denmark, this has driven up standards in their health service and is enormously popular with patients. The effect of it has been to improve efficiency in state hospitals. Very few patients have ended up going to private hospitals simply because they have had their treatment in the local publicly run hospital on time.

I particularly want to see this approach apply in mental health where at present service users have precious few rights. Too often people are left waiting interminably for access to treatment. Cognitive behaviour therapy, for example, is simply not available in many areas. This is surely not acceptable. We are dealing here with some of the most vulnerable people. They should have the right to treatment within a clearly defined period of time.

However patient empowerment must go further. I want to see patients controlling their care with budgets devolved to individuals for long term and chronic conditions. Direct payments and individual budgets have been successfully empowering social services users for years. There is clear evidence that people prefer it and feel it matches care to their needs. There is also evidence that this approach has improved access to care for disadvantaged ethnic minority groups.

This approach could also make a critical difference for those with a mental health problem. They could refuse to go on a waiting list for a hard to find NHS counsellor and could instead receive a cash equivalent to see an independent practitioner. This would be backed up by reliable and easily accessible information to guide patients through the system.

Campaigns up and down the country against hospital closures show that people care passionately about their local health services, yet feel they have no voice. I want to bridge the democratic deficit in our NHS. Decisions about our local health services are currently made centrally by Whitehall, shrouded in secrecy. Surely the body which commissions health care locally, the primary care trust, should have its board elected by local people rather than being appointed centrally.

People who work in the National Health Service are very resistant to yet more reorganisation. But this proposal simply makes PCTs – or locally elected health boards, as we propose calling them – accountable to the community they serve rather than to the Secretary of State.

An analysis of responses to our recent NHS survey which we have conducted in target seats around the country, shows that this proposal is very popular with the public. And it is based on the model which has been so successful in both Denmark and Sweden. But there should not be one single model imposed centrally. If local people vote for it, the local social services authority should take on the commissioning function. In any event we must argue for integration of health and social care.

The NHS is a remarkable national institution, which I care passionately about. I am wholly committed to it remaining free at the point of use, funded from progressive taxation and accessible to all for the next 60 years. But it cannot do this without urgent and fundamental reform which breaks the stranglehold of big government and trusts communities to decide on their local health services and trusts people to play a central role in decisions about their care.

The Party Press release can be found here, whilst the policy paper can be found here.