Nye's baby is safe in Alan's hands

Alan Milburn is no Nye Bevan. When Tony Blair deliberately draws comparisons between Milburn's National Plan for the NHS and Bevan's 1948 creation, he overstates his case. What Bevan created, Milburn is tinkering with: whereas Nye's name will still be one to conjure with a decade from now, Alan Milburn's will more likely be the answer to a tricky pub quiz tie-breaker. But perhaps a new Bevan was not what the NHS needed. The problems of the NHS were not so severe that yet another restructuring was called for. The Tories tried that, and it resulted in few improvements.

Alan Milburn is no Nye Bevan. When Tony Blair deliberately draws comparisons between Milburn's National Plan for the NHS and Bevan's 1948 creation, he overstates his case. What Bevan created, Milburn is tinkering with: whereas Nye's name will still be one to conjure with a decade from now, Alan Milburn's will more likely be the answer to a tricky pub quiz tie-breaker. But perhaps a new Bevan was not what the NHS needed. The problems of the NHS were not so severe that yet another restructuring was called for. The Tories tried that, and it resulted in few improvements.

Consolidation of best practice, improvements in delivery, a rediscovery of pride in service, more power and information to patients. These were what was required. These, we hope, are what will emerge. Indeed, unlike Labour's 1997 waiting-lists pledge, Milburn's plan is notably free from gimmicks. That is to the good. Most medical professionals agree that the waiting-lists target was an expensive distraction. Targeting waiting times, rather than lists, is a wholly sensible switch which, without the millstone of that pledge, Labour should have made years ago.

Beyond the welcome statistics of doctor and nurse numbers, new hospitals and waiting-list cuts, Milburn's most significant changes are cultural. "Consultant is king" is an outdated way of working. As any patient who has tried casually to read doctors' letters upside down from a consultant's desk can assert, the present culture of secrecy is frustrating and insulting. Milburn plans for patients to hold their own records, and for letters between doctors to be routinely copied to patients.

Meanwhile, newly qualified consultants will get better pay - but will be obliged in return wholly to practise within the NHS for seven years. Too many hospital wards are dirty, too much food barely edible. Now we will have a "patients' advocate" to whom we can complain. This is not a minor issue: as a result of poor conditions, hospitals - supposedly a place to recuperate - are too often havens for infection.

If this all sounds too good to be true, it probably is. The NHS has not been "the envy of the world" for years - and despite Milburn's efforts, it probably won't be again. But by imaginatively looking to the future, Milburn and Blair have ensured that there's life in the old dog yet. The National Plan leaves the Tories floundering for a response.

Cynics might argue that by aiming for 2008 to deliver much of the improvements, the Government has ideas above its station: to see whether it can fulfill its promises we would need to re-elect Labour - twice. But better to aim for long-term incremental improvement than for instant and diversionary gratification. Anyway, this plan should certainly see Labour safely through the first electoral hurdle next year. Milburn's legacy may not be as memorable as Bevan's. But, in its own way, it could be as significant.

Comments