Dorrell takes the bloody battle for a healthy NHS to Labour's door

Stephen Dorrell talks to Colin Brown about the Tories' pledge to the health service
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The Independent Online
Stephen Dorrell is on a roll. Having won a real-terms increase on his health budget of around pounds 500m, he will set out this week to put Labour on the defensive on the health service with a White Paper committing the Tories to funding it from taxation.

A Service With Ambitions will give the strongest commitment ever by the Conservatives to the NHS since it was founded by Clement Attlee's Labour government 50 years ago.

It will carry a personal endorsement by the Prime Minister, staking out the Tories' "wholehearted" commitment to the founding principles of the NHS as "part of the fabric of Britain".

It also stakes out Mr Dorrell's position firmly on the left of centre of the Tory party for the time when the leadership election takes place.

He told The Independent in an exclusive interview that the NHS White Paper would say that the health service was affordable as a tax-based system, and he rejects right-wing suggestions that it should be limited to a safety net for the poor.

An influential right-wing think-tank, the Adam Smith Institute, recently suggested in a report that the NHS should have a "core curriculum" of provision. Items, such as ear grommets, which fall outside the core should no longer be available on the NHS. The aim would be to make ends meet in the NHS by limiting the scope of the service available by rationing.

It goes to the heart of the controversy over Child B - the cancer sufferer denied treatment on the NHS. She received it through a benefactor, but subsequently died. Mr Dorrell says rationing - he calls it "prioritising" - will be part of his White Paper, but he rejects the ASI approach. "I don't buy the core- curriculum idea at all. It is very close to saying the NHS is a safety net. That is the opposite of what I want to do. This White Paper sets out my commitment to the delivery of universal health care, high-quality care and available on the basis of need. These three principles I regard as being founding principles of the NHS and explicitly not a safety net service."

He has rejected the advice of a close friend, John Maples, a former minister, who advised John Major to keep the NHS out of the news in the run-up to the general election.

Mr Dorrell believes that strategy was falsely based on his opponents' perceptions of the Tories on health.

He is taking the battle to Labour on its strongest issue: he recently published a White Paper on creating a primary care-led NHS; a bill implementing the plans to give family doctors more freedom to widen their services is shortly to be introduced in the Lords; and a second primary care White Paper will be published in December to give it another boost.

This week's NHS White Paper is part of a wider strategy for stealing Labour's thunder on the NHS. "We have had five years where we have argued about managing the service, and that's an argument that is essentially over. Labour are not going to uproot the management reforms that are in place. It's a chapter that is closed. "What I am seeking to do is to look forward to the development of health care over the coming period."

It will, he says, answer very directly two questions that it is said politicians will not confront: whether the health service is affordable; and, as a tax-based system, the need to set out priorities.

"The NHS - far from being a problem in affordability - by international standards, is the best answer to that problem."

Priority-setting is not new, he says. The Guillebaud committee in 1952 - the year Mr Dorrell was born - admitted the NHS could not afford to do everything without "very considerable additional expenditure". Finite resources have been chasing infinite demand ever since.

Being a wily politician, Mr Dorrell is not about to start playing God by advising the doctors on what should be available on the NHS.

The American state of Oregon tried that, but he rejects it. The White Paper will not be prescriptive. It will set out the parameters of what the NHS should be doing, and leave it to clinicians to decide.

Critics, including the cross-party select committee on health, say this has led to a patchwork developing in the NHS, with some treatments, such as IVF, available free on the NHS in some areas and not in others.

"The application of the principles to a specific patient must always be the responsibility of a patient's clinician. Otherwise, it will undermine that relationship.

"But the clinician is entitled to expect that the system provides a framework for making clinical priorities."

Labour may always win on the NHS. But Mr Dorrell does not intend to let Chris Smith, his Labour shadow, have a walkover.