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Pivotal moment for Labour
Mavis Skeet
Mavis Skeet died after her cancer surgery was repeatedly postponed
On the eve of the last general election, Tony Blair warned voters they had just 24 hours to save the NHS.

Three years later the NHS reforms to be announced on Thursday might be key to the future of his Labour administration.

As the party which established the NHS in 1948, Labour has always seen the health service as a political trump card.

However, the prime minister has failed to convince the public that his government has done enough to ensure the future of the NHS.

For each new initiative that has been trumpeted by the Department of Health, there has been a damaging headline highlighting a failing in the health service.

For the last two winters the public has been bombarded with images of patients waiting on trolleys in crowded corridors as hospitals struggle to cope with surging demand.

Ministers tried to blame this year's problems on a flu epidemic, but officials showed that the number of cases was nothing out of the ordinary for mid-winter.

Labour's image has also been severely dented by a series of high profile cases where patients had been badly let down by the NHS.


Steve Harley
Steve Harley's cancer was repeatedly missed
Doctors cancelled surgery on 74-year-old cancer patient Mavis Skeet four times because of a shortage of beds at Leeds General Infirmary.

When Mrs Skeet finally underwent exploratory surgery, it was found that her tumour was inoperable. She died weeks later.

The case of Barnsley businessman Steve Harley glaringly illustrated grave flaws in cancer care in the UK.

Mr Harley's oral cancer was misdiagnosed by different doctors on 19 separate occasions.

A swift diagnosis might have enabled doctors to operate on the cancer, instead the tumour grew so large that Mr Harley was forced to undergo a course of intensive chemotherapy to try to shrink it before surgery could even be contemplated.

The headlines do hide the fact that real progress has been made. More patients are being treated than ever before by the NHS, and although some still have to wait for years for treatment, 70% receive surgery within three months.

A campaign to encourage more people into the nursing profession - backed up by substantial pay rises for existing nurses, and the creation of a new grade of supernurse - has had limited success.

The telephone helpline NHS Direct, which enables patients to receive medical advice from a trained professional, has also been warmly received, although a recent study found that it has had little impact on cutting the numbers of patients who turn up at casualty.

Waiting lists

NHS Direct
NHS Direct provides phone advice
Ministers have also achieved their target of cutting 100,000 people from the waiting list - but for little political gain.

Critics said the target was only achieved by forcing NHS managers to play the numbers game.

Patients with easily treatable conditions were fast tracked at the expense of other more deserving cases, they said, while many other patients were simply dumped on the waiting list for initial consultation so that they did not show up on the official figures.

Certainly, the government has been very active in its attempts to reform the NHS, and significant investment has been made.

However, its policy of announcing and then repeatedly re-announcing cash sums has blunted the impact.

Never was this more graphically illustrated than by Chancellor Gordon Brown triumphant announcement of a huge increase in NHS spending in his 1998 Comprehensive Spending Review.

Critics were initially placed on the back foot, but soon discovered that the headline figures were hugely inflated by creative accounting techniques.

In reality, spending rose by little more than the rate under the previous Tory administration.

Mr Brown, however, learned his lesson. In this year's budget, he pledged to increase health spending by more than a third, from 50bn to 69bn over the next five years.

The NHS, however, is a fiscal black hole, and, with new and ever more expensive medical technologies and drugs coming on stream, even this spending boost may not be enough.

Medical profession

Ministers must also tread carefully in their dealings with the medical profession.

The powerful British Medical Association was delighted when Labour swept away much - although not all - of the NHS internal market soon after coming into office.

However, that initial goodwill has long since been dissipated.

Morale in the medical profession has been broken by a series of high profile scandals, starting with the furore over heart operations at Bristol Royal Infirmary and continuing just this week with the erasure from the medical register of the errant gynaecologist Richard Neale.

Health Secretary Alan Milburn has pledged to reform self-regulation of the medical profession, and while doctors accept this is inevitable, they fear a heavy-handed and counter-productive alternative.

Thursday's NHS plan must be seen to have an impact, and quick.

Former Health Secretary Frank Dobson boasted during his time in office of turning around the NHS supertanker.

Mr Blair must be seen to take a firm control of that supertanker if his administration is not to run aground.

See also:

01 Jun 00 | Health
11 May 00 | Health
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