BMA warns of service 'still in third division'

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The launch of the NHS plan was greeted with approval by medical, nursing and social services organisations but was met with taunts in the Commons.

The launch of the NHS plan was greeted with approval by medical, nursing and social services organisations but was met with taunts in the Commons.

Tory leader William Hague warned there would be a "vast gulf" between the plan and what actually happened.

Charles Kennedy, the Liberal Democrat leader, claimed that by sticking to Tory spending limits, the Government had increased waiting lists and bed shortages over the past three years.

Professional organisations were more enthusiastic, however, although they sounded warning signals of battles to come. The British Medical Association said the increase in doctors, while welcome, would still leave the UK a long way short of European standards.

By 2004, the UK would have two doctors per 1,000 head of population. That would still leave Britain in the "third division of the world's health systems", the BMA said. Greece already has four doctors per 1,000, Germany 3.4 and France 2.9.

Dr Ian Bogle, chairman of the BMA, said: "Some aspects of the plan are, however, unacceptable in their current form and will require detailed discussion with the Government.

"We have major concerns about the proposals to alter doctors' contractual arrangements which will bring no benefit to patients.

"The proposals to prohibit private practice for new consultants after they have fulfilled their NHS commitment could drive doctors out of the NHS, further exacerbating workforce problems."

He accused the Government of ducking the issue of alternative sources of funding for the NHS. "The BMA considers this has not been studied in sufficient depth," he said.

The NHS Confederation, representing NHS managers, called the plan "radical" and "brave". The challenge for management was now not so much to do things in more efficient ways but to do them in completely different ways.

Nigel Edwards, policy director, said: "There are no simple and quick fixes for the problems of the NHS. The Government has been brave to face head on the really difficult problems facing the NHS ... how to move to common standards of performance and how to persuade clinicians to do the most effective things, not what they have always done."

Ruth Lea, head of policy at the Institute of Directors, welcomed the "breakdown of ideological objections" to using the private sector. "However, we are concerned that the national plan is not radical enough. There will surely come a point when governments will have to concede that nearly all patient expectations, which are rising inexorably, cannot be met through taxpayer-funded health care.

"We still have major doubts that the NHS, with its million employees and huge budgets, is manageable. The NHS is the last of the late 1940s monopolistic nationalisations, and it shows."

A spokesman for the Patients' Association said: "There are some very good ideas in this plan but now these things have really got to happen and the money has got to be there.

"It's all very well the Government saying they are going to tie consultants into the NHS but unless they give them the financial incentives the consultants will just go abroad.

"It is great that they are acting but they have to ensure that all these pledges and promises now happen."

Nurses welcomed the Government's new health service blueprint as "a plan to save the NHS". The Royal College of Nursing general secretary, Christine Hancock, said: "Today we got a survival plan that puts patients first and tackles the hardest issues facing the health service.

"We're optimistic because every good idea in the plan is already happening somewhere in the health service. These ideas work and with the right support and opportunities, nurses and doctors will turn them into a reality for all patients."

The president of the Royal College of Physicians, Professor Sir George Alberti, described the plan as a "once-in-a-lifetime opportunity".

He said: "At last we have government recognition of the shortage of doctors and beds in England and a commitment to tackle these problems."

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