[A-List] UK state: political realignment

["Michael Keaney" <michael.keaney@xxxxxx>]

Parties edge closer on health as Tories unveil Blairite plan

John Carvel, social affairs editor
Wednesday March 12, 2003
The Guardian

The Conservatives yesterday unveiled a Blairite health policy that left the
main parties closer to each other than the large number of Labour rebels
anxiously awaiting publication of the foundation hospitals bill tomorrow.

Iain Duncan Smith and Liam Fox, the shadow health secretary, said they
wanted all NHS acute hospitals to gain foundation status and compete for
patients. That is close to the prime minister's goal.

As with Labour's medium-term ambition, GPs would be free to send patients to
the best hospital with the ablest doctors and shortest waiting list, with
the hospitals competing on quality, but not on price, as allowed under the
Tories.

A Conservative consultation document, entitled "Setting the NHS Free", said
that politicians should be "taken out of the day-to-day running of the NHS,
allowing them instead to focus on a regulatory role".

This resembled a persistent theme in health secretary Alan Milburn's recent
speeches, calling for decentralisation of decision making to the local
primary care trusts which, from April, will control 75% of England's NHS
budget.

However, the policies are not identical. The Tories say they would abolish
centrally set targets, a core Labour feature. After decades of persistent
organisational change, the Conservatives want to leave present structures
intact, but shed 20%-30% of Department of Health staff to put more managers
in the front line.

The draft said nothing about how much a Tory government would spend on the
NHS, how it would raise funds or how patient choice would be extended. But
Mr Duncan Smith echoed Labour ministers when he pledged the NHS would "offer
high-quality care, free at the point of use and irrespective of the ability
to pay".

On foundation hospitals, the Conservatives backed Mr Milburn's position in
his tussle with the chancellor, arguing that trusts should be free to borrow
money or raise it by issuing community hospital bonds. Frank Dobson, the
former Labour health secretary, warned last night of "a growing threat to
the NHS" as the government developed the foundation hospital proposal into a
more far-reaching plan to make patients bear part of the cost of treatment.

"Usually the threats of competition and charges come from the Tories. At the
moment they are coming from the government," he said.

Tony Blair, in a foreword to Peter Mandelson's book Progressive Governance,
backed a "mixed economy" in healthcare, including "co-payments" for health
and other services.

Mr Dobson countered that "co-payments mean charges".

"Charging people for their healthcare may be necessary to meet the extra
cost of farming out NHS services to the private sector," he said.

"It may be logical, but it is scarcely Labour, even New Labour.

"The proportion of NHS money spent on bureaucracy doubled after competition
was introduced [under the Conservatives], while waiting lists exceeded 1m
for the first time.

"The government should learn the lessons of what happened last time."