LEADING ARTICLE : After the vote - the debate

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Never mind last night's vote. It was more about a chance for the Opposition to savage the Government than about the NHS. Which is a pity, because getting health care right is more important.

It is natural for Labour, a party that still identifies itself with the creation of the welfare state, to treat the NHS more as a monument to be preserved than a service to be modernised. Labour says it wants a "moratorium" on closures, and to "slow down the pace of change". In March, this newspaper supported the King's Fund's call for assurances that adequate services are in place before London hospitals are closed, but we have never defended the status quo. No one wants patients being left on trolley beds or panic shutdowns due to overload, but a moratorium on change is not the answer.

Labour ought to be racing the Tories for the title of being the modernisers of health care. To be fair to Virginia Bottomley (it's a rotten job but someone's got to do it), in this sprint, she is ahead.

Three distinct issues were muddled together in yesterday's debate: one about the future of accident and emergency (A&E) services, another about the concentration of research and teaching hospitals in London, and a third about care for the elderly and the mentally ill.

Let's take A&E first. Margaret Beckett, Labour's health spokesperson, talks about "bed shortages". But physical space for additional patients isn't the problem. Much A&E work doesn't require beds. The occasional closure of one A&E unit in London is a management, not a policy problem; it can be coped with if there are other services nearby. The Government's idea of splitting A&E units into a series of hi-tech specialist units to deal with severe cases and a larger number of cuts-and-bruises centres is a reasonable way to modernise and cope with unexpectedly rising demand.

Some problems in A&E are the fault of the doctors. Juniors no longer have to serve time in A&E. Many are opting to avoid it, creating shortages that can only be filled in the short term by expensive overseas recruitment or higher salaries. In applying pressure to shorten waiting lists for non-urgent treatment, the Government has intensified this shift of staff away from A&E.

On teaching hospitals, the Government has been right to confront the ghosts of history. The big London teaching hospitals are not all excellent, and it is absurd that so many of them are still in London. Labour points out that increasing the amount of primary care has led to an increase in hospital referrals. But that's no argument against rationalising hospitals. We don't have hospitals with the right specialisms in the right places.

The reductions in "beds" in geriatric and psychiatric care reflect changes in the nature of treatment for the elderly and mentally ill. Now that it is increasingly focused on shorter stays, it is appropriate that funds go into making community care work. Mrs Beckett should be criticising the Government not for bed reductions, but for failing adequately to organise modern community services. Labour could outflank the Tories with a vision of high-technology medicine, non-invasive surgery, new mobile community units, combined with more community public health effort, thus breaking down the antique distinction between health and social care, which is meaningless to consumers.

It's time for Tony Blair to give a clear signal that he wants to be a moderniser in health as much as in other areas. If Mrs Beckett is unwilling to take on this role, he will have to find someone who is.

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