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Wednesday, 22 March, 2000, 17:50 GMT
NHS reform: Blair takes charge

The NHS has been challenged to reform
The theory that funding the NHS is like throwing 50 notes into a bottomless pit is about to receive its most comprehensive test.

If the government's latest massive cash injection disappears without trace - as many believe it could - it could be the final proof.

The money could be very easily absorbed...If that were to happen, then you have to fear for the future of the NHS

Adrian Towse, Office of Health Economics
But as the billions roll towards the edge of the UK's underfunded health service, Tony Blair and his ministers made it clear that they have no intention of simply watching them plummet off into the darkness.

On Wednesday, Mr Blair took the unusual step of following up his chancellor's Budget statement - with the promise that the extra money comes attached to some hefty strings.

"You challenged us to come with the money and we have done so." he told the Commons. "We rose to your challenge and now we ask you to rise to ours."

Now, he says, the NHS now has to face the "hard necessity" of reform.

All of the measures he went on to outline are familiar ones - computerisation, more inspection, streamlined appointment and hospital admission systems, more investment on prevention of illness and cooperation between social services and health services.

Many of these aims were set out last year or the year before by Labour, with individual action plans stretching as far as 2010.

What has changed is the approach to their introduction, and the hands-on technique adopted by Mr Blair shows how large the state of the NHS now figures in the run-up to the next General Election.

The government is now setting up five new dedicated units to pursue change in the NHS, and a new Cabinet Committee to oversee them.

An overarching four-year action plan will be published soon.

The independent think tank The King's Fund said that hospitals had been deluged with different initiatives and priorities in recent years, and called on the government to pick out which were the most important.

A spokesman said: "What we should see now is a really solid plan over four years telling managers which things they should be doing first."

'Pay off debts'

The King's Fund also wants some of the huge financial deficits plagueing hospitals and health authorities to be paid off.

The cash injection, coupled with a promise to consult more actively with the profession over the changes, appears to have won over even the previously dissenting British Medical Association (BMA).

A spokesman for the BMA, whose leaders last year were critical of the pace and volume of change, is now speaking of the new "enthusiasm" for reform.

The money, it says, is roughly equivalent to the amount it has been calling for "for years" to bring the service up to an acceptable level.

Surgeons are under pressure to cut waiting lists
However, the government and the BMA could still fall out over some of the "priorities" for the NHS.

Ministers are still likely to want to fulfil their pre-election pledge to cut waiting lists for operations.

Progress towards this has been badly disrupted by this year's flu crisis, and success before the next election could involve paying large sums, either to have some patients treated in the private sector, or to pay NHS surgeons and agency nurses to work extra sessions.

We rose to your challenge and now we ask you to rise to ours

Tony Blair
Much of the impact of another large cash injection for the NHS announced early in this Parliament was lost because the government announced the sum using a culmulative formula denounced as "misleading" by many.

On closer examination, their promise of 21bn turned out to be closer half that sum.

The money announced in the Budget, however, has been pronounced completely free of spin.

Some health economists criticised Tony Blair when he said he could lift the UK's health spending to match other countries in Europe.

But the Office of Health Economics now concedes that he is virtually on target to achieve it.

One of its directors, Adrian Towse, said: "The key issue is whether the money will be spent wisely."

He predicts that much of it will be set aside in "ring fenced" funds, which can only be spent on modernisation projects.

"The money could be very easily absorbed in base budgets without any change in performance," he says.

Should the pit prove to have no bottom, then the consequences for health service could be far-reaching, he says - regardless of Tony Blair's pledge to defend it.

"If that were to happen, then you have to fear for the future of the NHS."

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See also:

15 Mar 00 | Health
Blair challenges GPs to change
03 Mar 00 | Health
Blair's health pledge 'flawed'
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