Lib Dems find value in reforms

The Liberal Democrats have a new health spokesman. As a result, they have taken a new look at the Government's reforms of the National Health Service. "And we've come to the conclusion that what we prefer to call the commissioner/provider relationship - mainly because we think the word purchaser gives it the wrong timbre - has some value," their spokesman, Alex Carlile, said last week.

"On the other hand, we believe that GP fundholding in its present form is distorting the service - against some patients and doctors and for some patients and doctors.

"It should not be abolished at a stroke, but we should be aiming, not at single-practice fundholding, but at joint commissioning groups. The Labour Party, you will notice, is saying almost exactly the same thing."

Unlike Labour, however, and subject to a party conference decision on a new health document due out shortly, the Liberal Democrats would allow fundholding to survive.

"We would allow GPs to be fundholders but subject to an annual accreditation system." That would cover quality of management and services, while an annual health plan would be submitted for approval to the local health commission. However, Mr Carlile hopes individual fundholding would "wither on the vine, because joint commissioning arrangements offer the potential to be more effective".

In Nottingham, for example, he says 200 GPs working with the local health authority have made changes that match anything fundholding has achieved and more, without the administrative burden. Nottingham is a model of which Labour too approves. "If you analyse Labour's policy, it is going to be unrecognisable from old socialist health policy, with its dedication to a massive, corporate NHS," Mr Carlile said.

"The language is somewhat different from ours, because Labour has more to conceal from the health unions and others in a change of policy. But I think Labour and ourselves are likely to be quite close on the broad thrust."

None the less, he says, the parties come from different starting points and some "stark differences" remain, though they may prove larger in principle than practice.

"We have absolutely no opposition to a system in which some elective surgery is purchased from the private sector. If the private sector can show it can do the job better and quicker, that's fine by us." A contribution from the private sector to doctor and nurse training would, however, be required if it were to receive significant amounts of NHS business. Likewise, the party has few problems with the private sector financing and running hospitals for the NHS. The other main change the party's new policy will bring is the abandonment of suggestions that health would go under local government.

NICHOLAS TIMMINS