Labour health plans: Analysis

More nurses: 20,000 more by 2005 promised

The Labour Party manifesto itself reveals little new about their plans for the health service.

Although newspapers have hinted about a far wider role for the private sector in health should Labour be re-elected, none of this is set out in the document itself.

However, Prime Minister Tony Blair says he is seeking a mandate for far-reaching reform of the public services over the next four years.

Labour had, in the NHS Plan published last year, already outlined a long-termist approach to the NHS, stretching out as far as 2010.

Ministers talked about the difficulties of revamping the NHS as similar to turning around a supertanker - and they were frank that their ambitions for the NHS extended far beyond a single term in office.

Even then, almost 10,000 new doctors, and 20,000 new nurses were promised by 2005 - the end of a second term.

The waiting time targets - down to a maximum three months for outpatient appointments, and six months for operations, were also unveiled at that point.

Factory healing

The manifesto serves as a reminder of other intentions - for example, specially-created surgery units to specialise in diagnosis and treatment of particular conditions.

Eight of these so-called "health factories" will be fully operational by 2004, treating approximately 20,000 patients a year.

In addition, the airline-style "booking service" for outpatient appointments, announced a year ago, should be in place by 2005 in all hospitals, say Labour.

Year on year, the NHS budget will increase by 6% for the next few years at least, as the vast sums earmarked to drive the NHS Plan through are pushed into the health service.

However, while most in the health service welcome the extra billions, there are persistent arguments about whether the government has been spending them in the right areas.

And professional bodies such as the British Medical Association (BMA) have warned that more doctors would be needed to cut waiting times in the way the government has pledged.

In real terms, says the BMA, the pledge to bring in 2,500 new GPs in reality meant an 900 extra - as many were already in training.

A spokesman said: "Although any expansion in the number of doctors and nurses is to be welcomed, the BMA is disappointed that the Labour Party is not more ambitious in its plans for GP expansion.

"We estimate that we need 10,000 more GPs in England alone in order to give patients more time with their doctors and to provide an all round high quality service.

The BMA is also cautious about the plans for surgery centres dedicated to single conditions.

"Some cold surgery units are operating already - for example the unit at the Central Middlesex Hospital in London.

"Success depends on being integrated with wider DGH facilities and on very careful selection of patients. Single operation units may not always be suitable for elderly patients with multiple health problems."

GP cooperation

The cooperation of GPs will be needed to press on with the radical reforms of primary care outlined in the NHS Plan.

The government wants to reduce the numbers of health authorities by two-thirds by a series of mergers - handing out many of their responsibilities to primary care trusts, groups of GPs and other health professionals covering whole towns or districts.

It is the prospect of increased private involvement within the structure of the NHS that has interested most commentators.

The Kings Fund, an independent think-tank on health, is urging extreme caution, saying the government risks the "Balkanisation" of different parts of the health service as separate companies compete for business.

"The fragmentation of the railways is a warning about the potential impact of dividing up public services between multiple private providers."

Labour marked its first term in office by setting ambitious targets for the NHS.

A second term would have to be spent meeting them - altogether a tougher proposition.