Leading article: The wrong sort of medicine

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The Independent Online

Gordon Brown signalled yesterday that he is preparing to give the National Health Service a 60th birthday present in the form of a "constitution". Excuse us if we do not join in the celebrations at this news.

The Prime Minister has spoken of a document that will set out "rights and responsibilities" linked to entitlement to NHS care. But talk of "responsibilities" in such a context is pretty meaningless. Will doctors have the formal power to refuse treatment to those who have not met their "responsibilities" to live healthily? This is highly unlikely since it would undermine the principle of universal access on which the NHS was founded. And if doctors began to refuse treatments on an informal basis, they would soon be challenged in the courts. As for patients' "rights", is this not merely stating the obvious? British citizens have had a "right" to treatment for 60 years.

This sort of headline-chasing gesture politics is precisely the sort of thing Mr Brown should be avoiding in 2008. With regard to the NHS, the Prime Minister should be concentrating on sorting out the actual service, rather than formulating a useless new blueprint for it.

And he should start by asking some basic questions. Why, seven years after the Government announced they would be abolished, do many hospitals still have mixed wards? A survey of 2,500 patients last March found 25 per cent had shared a ward or bay with members of the opposite sex. Why are MRSA infection rates still so high, and those of Clostridium difficile rising? Why are cancer survival rates in Britain among the lowest in Europe? Money is not the answer to any of these deficiencies. The Treasury's spending splurge on the NHS over the past eight years has not delivered good value for money. In any case, there is no more left in the public purse.

Mr Brown is correct about one thing. A central challenge for the Government is to make the NHS more holistic, like the Cuban healthcare system. The goal must be to prevent people needing treatment in the first place by encouraging healthier lifestyles.

But just as importantly, the Government must take on the vested interests that infest the monolithic NHS.

Instead of trying to run the service from Whitehall, Mr Brown should be devolving more power to local providers. More private sector treatment centres must be allowed to establish themselves. The state needs to move away from being a provider of healthcare and into a role of guarantor and commissioner of services.

The NHS enters its seventh decade this year. The best present Mr Brown could give the service (not to mention its long-suffering patients) is a heavy and uncompromising dose of reform.