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 Wednesday, 17 April, 2002, 11:05 GMT 12:05 UK
NHS faces huge change

The extra spending announced by the Chancellor represents a sea change in NHS funding.

For the last 50 years average growth has been around 3.5%. Gordon Brown proposes to invest 7.4% extra in real terms each year for the next five years to enable the NHS to catch up with its European counterparts.

In short, he has accepted the recommendations of the report into the future of the NHS lead by former NatWest chief executive Derek Wanless.

No government putting up taxes to pay for health will be prepared simply shell out the money without holding the service to account

But the need for additional money has thrown into stark relief an existing system that is failing to deliver.

The big question now is whether even with all these new resources the NHS in its present form can deliver the modern service envisaged by Mr Wanless and his team.

Obstacles

The obstacles are considerable - the first and most obvious is the shortage of capacity, and that means staff and facilities.

Ministers have nailed their flag firmly to the tax funding mast

Even with the government's planned medical expansion Mr Wanless says they could be 25,000 doctors short in 20 years time.

Apart from amending these plans there will be a need to redraw some of the boundaries between professions, with nurses increasing taking over roles previously undertaken by doctors and various forms of health care assistant picking up some of the work now done by trained nurses.

Equally demanding will be the need to move the NHS into the electronic age - family doctors still use envelopes introduced by Lloyd George for their patient notes.

The health service is a technological mess which has spent far less on IT than it should have done, much of it not well spent. That will have to change and change fast.

NHS leaders

Finding new and better ways of ensuring patients pass through the system efficiently and effectively remains a major challenge

Second is the question mark over management calibre - has the NHS got the necessary skills to bring about fundamental changes in the culture of the organisation and in its ability to deliver a more patient orientated service?

Few doubt that there is still waste in the system with machines being ordered without the staff to run them, with patients sometimes being subjected to a succession of professionals and with a gulf persisting between community and GP services on the one hand and hospital care on the other.

Finding new and better ways of ensuring patients pass through the system efficiently and effectively remains a major challenge.

If it is not solved then at least some of the extra resource will disappear down the proverbial black hole.

Third, it is clear that the divide between health and social care remains a huge roadblock to delivering high quality care.

The Wanless team favour some form of integration between health and social services, but that was not within their remit - they suggest this is a subject that will have to be revisited.

Political element

Over-arching all this is the issue of political control.

Most commentators now seem to agree that too much direction from Whitehall (or indeed from the devolved administrations in Cardiff and Edinburgh) can be counter productive.

They say that an endless stream of targets and directives stifles local innovation while sometimes creating perverse incentives.

At the same time no government putting up taxes to pay for health will be prepared simply shell out the money without holding the service to account - achieving that balance will also be crucial to the success of new Labour's NHS project.

The evidence so far is that they have struggled to find it.

Debate

All of this will leave wide open the debate as to whether our tax funded state provided system is the best way forward.

The government has shown that it is willing to consider opening up the supply side - handing over parts of the system or individual patients to the private sector including not-for-profit organisations.

Greater devolution to hospitals could also mean much more autonomy within the NHS family.

But from today ministers have nailed their flag firmly to the tax funding mast.

Mr Wanless has looked at other systems and found them wanting which leaves the way open for the Conservatives to offer some alternative approach.

So far they have been coy beyond saying that the existing system does not work - if they do produce a different model such as compulsory insurance, charges, tax breaks for private medical insurance or some other combination of these then for the first time since the NHS began the consensus on the NHS will have broken down.


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17 Apr 02 | Health
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