Bottomley 'making up' health policy: 'British Medical Journal' leading article criticises 'out-of-control NHS changes based on the short-term horizons of politicians'

VIRGINIA Bottomley and other health ministers are accused of 'making up' the health service changes 'as they have been going along', by an influential health commentator who is strongly critical of the lack of central planning.

Professor Chris Ham, director of the Health Services Management Centre, Birmingham University, in a leading article in tomorrow's British Medical Journal, says that the changes in the NHS are out of control.

His criticisms come within a week of warnings from Robert Maxwell, director of the King's Fund, who condemned unplanned, piecemeal bed closures in London and called for a halt to hospital bed closures in the capital. Both are an embarrassment to Mrs Bottomley.

Professor Ham, whose department is partly funded by the Department of Health and the NHS Executive, calls on ministers to return to the founding principles of the reforms, first set out five years ago in the White Paper, Working for Patients, to test their relevance today.

He acknowledges that the reforms are influenced by local development as well as government policy, but says: 'To this extent the changes introduced by Working for Patients are out of control, with developments being driven from the bottom up, not from the top down.'

He says there has been little debate about the direction of the health services in the longer term, and dismisses Mrs Bottomley's 'vision-of-the-future' speech last month as 'more an exercise in kite-flying than a carefully thought out analysis of issues'.

Professor Ham writes: 'The reality is that short-term political horizons dominate the thinking of politicians and militate against debate on matters of more fundamental interest.'

There is now enough information to fill in the gaps created by the reforms and refine them 'taking into account legitimate (as opposed to partisan) claims' of doctors. 'This may entail the politically uncomfortable acceptance that market principles won't guarantee the concentration of services in centres that produce the best results,' Professor Ham adds.

Alan Langlands, chief executive of the NHS Executive, said last night that Professor Ham's article was 'both opportunistic and subjective'. There was a sound, coherent and public policy, which included improving the mental and physical health of the population; providing quality services to meet individual needs, and ensuring partnerships with local authorities.

'The NHS is a remarkable, cost- effective institution, which takes pride in achieving results which compare favourably with other developed countries. Chris Ham's articles fails to recognise the achievements of NHS staff,' he said.