Labour's record on health

By Richard Hannaford, Health Correspondent

In their years of opposition the Labour Party became known as the party that would stand up for health and education - but have they? Labour promised to end the internal market, cut costs by removing bureaucracy and to promote the use of new technology in telemedicine. A Labour Government would, they promised, set new goals for improving social conditions affecting health. Spending on the NHS would go up and waiting lists would be cut. Richard Hannaford puts Labour's promises to the test.

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"Labour will end the Conservatives' internal market in healthcare." Labour Manifesto 1997

The Tories' internal market was the biggest thing to hit the NHS since its inception. But many viewed it as a prelude to privatisation and the contract culture had a difficult birth. It also led to a rise in administrative costs. The management bill rose tenfold in the first two years.

After Labour lost the 1992 election it revised its initial position of total opposition to the reforms. The purchaser-provider split will remain, but the emphasis is now on co-operation. NHS agencies will still be responsible for their own budgets and performance. Those which perform well will get extra cash. Poor performers will face sanctions.

"There are 20,000 more managers and 50,000 fewer nurses on the wards ... Labour will cut costs by removing the bureaucratic processes of the internal market." Labour Manifesto 1997

The Health White Papers state savings will be made by cutting bureacracy - £1bn in England. So far, the 1997 savings amount to £80m from measures taken by the Conservatives and £20m from cancelling the next wave of GP fundholders.

The government hopes to reduce the number of agencies which commission services. In England, 3,500 could be replaced by 500. Health Authorities are to be merged and GP fundholders subsumed into Primary Care Groups. This has yet to happen. There are also plans to cap management costs.

The Health Department has recently begun a new nurse recruitment campaign because a serious shortfall is forecast.

"Labour will promote new development in telemedicine - bring expert advice from regional centres of excellence to neighbourhood level using new technology." Labour Manifesto 1997

One of the biggest developments has been the piloting of the new telephone helpline, on which nurses answer patients queries. Over the next two years the scheme will be rolled out across England.

In England, Labour has dusted down the Tories' plan to link every GP practice with local hospitals through computers, NHS Net. The investment required is immense, the technical problems enormous, and the problems of maintaining patients' confidentiality huge.

Labour plans to have hospital test results available in all surgeries which are already computerised by the end of 1999. By 2002, access to NHS Net will enable GPs to have the latest specialist advice, make appointments and communicate at the touch of a button.

"Labour will set new goals for improving the overall health of the nation which recognise the impact that poverty, poor housing, unemployment and a polluted environment have on health." Labour Manifesto 1997

A White Paper on tobacco sponsorship is due out in the summer. That may be delayed until the European directive has been passed, but with the Germans opposing it at every turn, the directive may fail.

The thrust of the Green Paper on public health is for health authorities to draw up local Health Improvement Plans and local targets and goals.

To combat poverty and 'Health Inequalities', the government plans to create Health Action Zones (HAZs) and Healthy Living Centres. The first will be testing grounds where extra money and new initiatives are piloted to improve health. Healthy Living Centres will be a sort of health club for the masses - funded by the National Lottery. Again, progress on that front has been slow.

"We will raise spending on the NHS in real terms every year and put the money towards patient care." Labour Manifesto 1997

When Labour got its hands on the books it realised just how serious the financial situation was. Financial restraints were eased, but with the prospect of a huge increase in demand in the winter, the government began to pump more money into the system.

This year's Budget announcement saw an extra £500m on top of £1.2bn promised in August 1997. Taken with November's £300m, the total increase for the NHS is £2bn - a real terms increase of around 2.5%.

The government upset many in the service by staging this year's pay awards. At present a review of the grading system in the NHS is ongoing.

"Waiting Lists will be shorter" Labour Campaign Poster May 1997

One of the key pledges was to cut 100,000 patients from waiting lists. Originally this was a first step - now it is a promise to be fulfilled over the period of the parliament.

In trying to avert a winter crisis, the Secretary of State allowed non-urgent operations to be delayed and cancelled as long as emergency work was carried out immediately. Now, however, the government is beginning to fear it might not be able to fulfil the pledge at all. Frank Dobson has now set the NHS an ambitious target: to reduce waiting lists by more than 100,000 by next April.

Waiting times have also gone up. There are more than 60,000 people waiting longer than 12 months in England, and nearly 1,000 have been waiting longer than the Patients Charter maximum of 18 months.

Under review are mental health services, the new NHS Charter and the future of social services. The Royal Commission on the funding of elderly care will report within 12 months.

The government has made some tough decisions, most notably about hospital closures around London. However, the decision to overturn the closure of Barts was seen as a deliberately populist move, rather than for the long-term interest of the public.

Other events have damaged the Department: problems in the blood service, cancer screening in some hospitals, gaffes over new charges.

In general, however, the government has brought the normally sceptical and warring tribes of the NHS along with it and ministers have come through the first year relatively intact. Frank Dobson is now thought of not as a stopgap, but a safe pair of hands and unlikely to be reshuffled. Of the other ministers, Alan Milburn seems to be a rising star and looks destined for a Secretary of State-ship after July.