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Last Updated: Thursday, 24 June, 2004, 12:55 GMT 13:55 UK
Analysis: The NHS's challenge
By Caroline Ryan
BBC News Online health staff

GP consultation
The clock will start ticking from the moment a GP refers a patient
The government has pledged to radically slash the amount of time patients wait for operations.

By 2008, patients will have to wait a maximum of 18 weeks from the time our GP refers us for an operation to the time we actually have it.

It will require a significant shift from the current situation. So can the health service achieve this, and other goals, set for it?

Patients can currently wait up to 17 weeks for an out-patient appointment, then some more weeks for diagnostic tests before they are put onto the actual waiting list for the operation.

Let us, with doctors and local people, set targets that are more germane to the localities in which we live.
Graham Elderfield, Isle of Wight NHS Trust
At the moment, this is when the waiting-time clock starts ticking. The maximum wait is set at nine months.

The new target will mean patients must undergo non-urgent operations within 18 weeks.

Niall Dickson, chief executive of the King's Fund think-tank, says it will not be possible for the government to "wave a magic wand" to realise their aim.

He told BBC Radio 4's Today programme the target was "ambitious":

"It will need a lot of input into diagnostic services, more staff and more use of the private sector.

"The deadline of 2008 is possible, but it won't be easy."

Mr Dickson warned the target could mean other areas of care, such as mental health and public health could be neglected if the NHS focussed too much on targets in hospital care.

Gill Morgan, NHS Confederation chief executive said: "Delivering the targets will require new ways of working, better IT and the best use of all the capacity available, whether in the public, voluntary or private sector."

Dr George Rae, head of the British Medical Association's prescribing committee said the NHS could not deliver the desired improvements "as it stood" because of a lack of people and resources.

"We haven't got the capacity to meet these targets. Money needs to go in to attract new doctors and other healthcare staff."

James Johnson, chair of the BMA, added: "The more targets you have, the more difficult it is for hospitals to comply with them. There is a worry that the target culture has gone too far."

Not everybody in the NHS is unimpressed by the government's targets, however. Graham Elderfield, chief executive of the Isle of Wight NHS Trust said that in general, he welcomed them.

"They have enabled us to get us where we are today. They have been a good thing.

"But the government should now relax some of the national targets and let us, with doctors and local people, set targets that are more germane to the localities in which we live."

Choice 'divide'

One of the central planks of Labour's plans, like the Tories, is to increase the amount of say a patient has in where they are treated.

Such schemes have already been piloted. Last summer, patients in London waiting more than six months for an operation were able to choose treatment in an alternative NHS or private hospital.

We're really moving to a stage where both political parties are saying the NHS no longer need be the provider of treatment
James Johnson, chairman of the British Medical Association
It was an extension of a scheme which had been offered to heart patients in the capital, in which around half of those eligible opted for faster care elsewhere.

But Mr Johnson, said: "The plan to give everyone the choice of four or five hospitals could work in urban conurbations such as London, but it won't be possible for someone having a baby in an isolated part if the country."

But Gill Morgan, chief executive of the NHS Confederation said there was choice available, even in rural areas - although it might involve different ways of providing care, rather than choosing between different hospitals."

'New philosophy'

As with the Conservative health plans launched on Wednesday, Labour's proposals involve more use of the private sector.

However, under Labour's plans NHS managers will "buy-in" capacity from private hospitals, whereas the Conservatives say the money will follow the patient.

Mr Johnson said the increasing use of the private sector by the NHS was "a fundamental shift".

"The NHS is there to pay for the treatment, to commission the treatment, but ultimately who provides it doesn't matter so long as the provision is of a particular standard and it comes in at NHS cost.

"That's a very new philosophy, and one which a lot of members of the public and of doctors will have difficulty coming to terms with."

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