Leading article: The NHS needs a dose of tougher medicine

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The Government introduced performance targets into the National Health Service for the noblest of reasons: to make the system more responsive to the needs of patients. Since 1997, health ministers have stuck to their demands that operation waiting lists and waiting times must be drastically reduced. And so they have. But the management technique has been taken to a damaging extreme. Ministers have attempted to govern almost exclusively through targets, rather than using them as a general guide. The 2000 NHS plan notoriously set more than 200 specific objectives, covering everything from staff levels to the numbers of patients on drug treatment programmes.

The results have been damaging. NHS Trusts and medical staff have been encouraged to play the system though expedients such as discharging patients prematurely from Accident & Emergency. Targets have had perverse effects. The objective of giving families a guaranteed GP appointment within 48 hours led to patients being unable to make appointments more than two days in advance. Worst of all, this plethora of targets has created a service in which the main priority is to meet central directives rather than respond to the immediate needs of patients. That stifling of initiative is no doubt one of the reasons it has taken so long for the revolutionary operation safety techniques, on which we report today, to be adopted.

In fairness to ministers, they have accepted that there is a problem and have begun to take action to change things. But the Conservatives are perfectly justified in launching a critique of the management culture the Government has encouraged in the NHS, as David Cameron did yesterday in a speech to the Royal College of Surgeons. It is the job of oppositions to point out the failings of governments.

Yet it is also the job of oppositions to come up with convincing remedies of their own; and the Tories have persistently failed to do this when it comes to public health care. Mr Cameron argued yesterday that any government he leads will concentrate on indicators such as patient survival rate for illnesses including cancer and heart disease, rather than the Government's existing measures of success. The Tory targets will be health "outcomes", rather than bureaucratic procedure. This sounds good. But it leaves open the question of how those laudable ends will be reached.

This brings us to the heart of the matter. It is widely agreed that an unprecedented injection of public funds into the NHS over the past eight years has failed to deliver the expected improvements. This is because the funds were not matched by wholesale reform of the system. Health-care workers were left to carry on delivering services in the same old way, rather than being forced to become more efficient and responsive to patients' needs. The lesson should be clear. Any government that is serious about improving the NHS will need to take on the vested interests that bedevil the monolithic system.

The problem is that the Tories seem more interested in attracting the support of doctors and nurses disgruntled with the Government's clumsy management than in developing their own reform programme. The party is doing this for understandable reasons. The Tories have long been regarded as an enemy of the founding values of the NHS. Mr Cameron no doubt feels happier to have its employees on side. But he is in danger of making a strategic mistake. The best present the NHS could receive from the Tories as it approaches its 60th birthday is a promise of uncompromising reform. The Conservatives have a chance to be bold. Tearing down the unsatisfactory status quo is one Government target they must not jettison.

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