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Will money cure NHS ills?
Emergency patient
The chancellor wants a 'world class' health service
The government has committed itself to delivering a "world class" health service - but at a price.

Chancellor Gordon Brown used Tuesday's pre-Budget speech to warn that delivering a NHS fit for the 21st century will require a "significantly higher share of national income" being spent on health.

His comments are seen as a prelude to tax hikes in the coming years. But they also reveal the government's two-pronged approach to renewing the health service.

Last year, the government published a 10-year plan for the NHS promising shorter waiting times, better services and improved facilities.


I think we are someway off a world class health service

Nigel Edwards, NHS Confederation
Speaking at the time, Prime Minister Tony Blair said the plan's package of reforms would deliver a health service that would be envied by the rest of the world.

His chancellor, this week, qualified that statement by suggesting that "significantly more long term investment" was needed if the NHS was to become truly "world class".

More than money

But those on the front-line of medical care in the UK believe the solution may be more complicated. Additional money and existing plans may not be enough.

"Money is only partly the answer," suggests Dr Ian Bogle, chairman of the British Medical Association.

"This is a very welcome commitment and without getting the money right we cannot get everything else in place."

But Dr Bogle believes the government should also be turning its attention to staff shortages.

The NHS Plan promised an extra 7,500 consultants and 2,500 more GPs by 2004. The BMA believes even more doctors are needed and that more needs to be done to attract people into medicine.

Nigel Edwards, acting chief executive of the NHS Confederation, which represents health service managers, also wants to see a new focus on NHS staffing.

"It is not just money," he says. "We have to start investing in staff and facilities. But we also need to do more and be more imaginative about redesigning the roles of staff, and nurses in particular.

"We also need to change the style of management of the NHS. We need to change the way the Department of Health manages the service and stop it from trying to drive everything from the centre and give greater freedom to those on the frontline."

Officials at the independent think-tank, The King's Fund, believe NHS priorities have to be re-assessed.


A lot needs doing but there is a commitment to try do it from all of us

Dr Ian Bogle, BMA
"We would like to see shorter waiting times, much more emphasis on access to primary care, GPs being able to spend the time they want to spend with patients and patients having a much better say on how they want to be treated," says its spokesman.

The think-tank also wants to see a national debate on how the NHS should develop in the coming years.

"A world class health service is an aspirational thing. How exactly we achieve that, what that would look like and how much it would cost is for debate," the spokesman suggests.

Dr Bogle and the BMA have their own views of what a 'world class' NHS might look like.

"A world class health service is where doctors and patients have time together, where patients get sufficient time with their doctor and where doctors have time to do their job," he says.

"It is also a health service in which the patient has a right to much improved access to care and treatment in modern up-to-date surgeries and hospitals."

'Far reaching reform'

David Hinchliffe, Labour MP and chairman of the Commons health committee, believes far reaching reform is key to improving the NHS.

Speaking earlier this week, he said: "Clearly the NHS faces increasing demands. My concern is that we are avoiding debate about some of the key structural weaknesses that do, in the end, cost a huge amount of money."


We are an awful lot better than some countries but we lag behind others

A spokesman for The Kings Fund
All sides are agreed that the NHS is currently a long way off achieving world class status.

"I think we are someway off a world class health service," says Nigel Edwards, "and that is simply because of the serious shortages of doctors, nurses and other professionals. We are tens of thousands of staff short of what we need.

But he adds: "I think it can be achieved but a lot of discussions are needed before that. We have to make sure we do not promise more than we can deliver too early and that we keep frontline staff with us."

The King's Fund agrees: "If you look at how we compare to other countries, you will find that we are an awful lot better than some countries but we lag behind others.

"The important thing in delivering a world class health service is to keep the things we are good at and try to build up those areas where we are lacking."

Dr Bogle believes all sides are committed to working towards the goal of a 'world class' health service and that it can be achieved.

"I believe it can be achieved. It will require all those involved in healthcare provision.

"A lot needs doing but there is a commitment to try do it from all of us."

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Dr Peter Hawker, British Medical Association
"This is a long-term project that is vital to the health of the nation"
The government's pre-Budget report will be on 27 Novewmber


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27 Jul 00 | NHS reform
21 Mar 00 | Budget2000
27 Nov 01 | Health
27 Nov 01 | Business
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