Leading Article: Healing wounds in the NHS battle

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The Independent Online
FOR THE first time since 1987 the Conservative and Labour parties have begun to agree on the limited question of how the National Health Service should be run. There is not yet a consensus: fiery language still suggests deep division. But the technical demands involved in modernising the NHS are prompting politicians to offer surprisingly similar prescriptions.

Yesterday, Labour effectively conceded to the Conservatives that competition between hospitals for public funds is the best way to improve efficiency. The party's main health policy statement since the last general election accepts self- governing hospitals and a split between the purchase and provision of health care.

On the same day, Virginia Bottomley - whose party once threatened to let free enterprise loose in the NHS - announced her rationalisation programme for London hospitals. True, it acknowledged the signals from the market. But it avoided potential disruption by detailing a grand plan for gradual, managed change that any government over the past 30 years might have laid out.

No shortage of disagreement on detail remains. Labour is fiercely opposed to GP fund-holding because of the inequity and disruption that may result. Ministers want the entrepreneurship of family doctors to continue stirring up the NHS bureaucracy. The Opposition would also clamp down on private medicine in the NHS.

Labour would make health authorities and hospitals more accountable and end Tory nepotism. The Government, having secured the reforms and won much of the argument, would be wise to open up these institutions to greater public scrutiny.

These differences are, however, relatively minor given the important principles that the two parties now agree upon. It is to Labour's credit that, rather than threatening the NHS with another traumatic upheaval, it is acknowledging the best aspects of the changes.

Now that Labour and the Conservatives are only quibbling about the mechanics of the NHS, political debate should move on to the size of the health service's role in British life. The key question must be whether the NHS should continue to provide comprehensive health care and be funded almost entirely from taxation.

The right will argue for shrinking the NHS and introducing means-testing to save on taxation. The left will defend the status quo as value for money. This debate will represent a true ideological battle after the pseudo-war over how to run the NHS that now mercifully seems to be moving towards an armistice.

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