Labour plans for NHS `will not work'

NICHOLAS TIMMINS

Public Policy Editor

The political battle over Labour's plans for the health service was joined yesterday as Virginia Bottomley, the Secretary of State for Health, claimed "they won't wash and they won't work".

Labour, however, claimed the Secretary of State had been "wrong-footed" after the leak of the proposals in the Independent.

Margaret Beckett, Labour's health spokesperson, said: "She is desperate to say we have turned the clock back on the NHS when we will do nothing of the sort." Labour was proposing "sensible reform", not a "a major upheaval", she said.

Under Labour's leaked plans, NHS trusts would retain separate boards but be brought back into "a single organisation". They would no longer control their own assets or have statutory independence. However, a commissioner/provider split would remain. GP fundholding would go, but GPs would join health authorities in commissioning care under a variety of different local models.

Mrs Bottomley said the proposals "combine all the worst elements of old Labour socialism and new Labour fudge" at a time when the NHS was working well. "Labour mustn't be allowed to ruin it," he said.

However, Rodney Walker, chairman of the NHS Trust Federation, was surprisingly welcoming, saying "we are relieved that the Labour party do not propose to change the present system of separating purchasing from providing". Trusts also believed Labour recognised "the overwhelming necessity not to implement wholesale change" just as the NHS was coming to terms with the reforms.

Chris Ham, Professor of Health Policy at Birmingham University, who has advised Labour, said he had urged the party to keep the best part of the NHS reforms by retaining a purchaser/provider system. "It seems that message has been taken on board." He added, however, that a statutory split between health authorities and hospitals best did that, and "I think there is some way to go before the proposals sit with the kind of health service I think we need for the future".

Ray Rowden, director of the Institute of Health Service Management, said a real gain of the past few years had been GP involvement at a local level. It was, he said, "fine" to throw away fundholding, but it had proved effective and the question was "what do you replace it with".

Jeremy Lee-Potter, former chairman of council of the British Medical Association, said he was delighted Labour would be "going back to a national health service again and stopping this fragmentation".

Bob Appleby of the health service union Unison saidLabour seemed to have found a way of keeping the best of the reforms while getting rid of the internal market. Trusts appeared to retain significant freedoms while operating within a national service.

Mrs Bottomley, however, said Labour's plans would "inflict upheaval and turmoil in an ill-judged cause", and Roy Lilley, the former chairman of the Homewood NHS Trust and an aggressive pioneer of the reforms, dubbed Labour's plans "a disaster". Market mechanisms had allowed the service to focus on quality and costs, he said. "Take that away and it simply fudges the issues and puts us back to the fuzzy Forties."