Labour to keep elements of NHS changes

LABOUR said yesterday that it would retain but 'reshape' the purchaser/provider split at the heart of the Government's National Health Service changes - while claiming it would abolish the competitive internal market, NHS trust boards, and GP fund-holding.

The party said it would keep the separation between the purchase of health care and its provision, while 'democratising' health authorities and possibly the boards of NHS trusts to make them more accountable. The trusts, however, would retain a degree of self-governing status rather than being directly managed by health authorities.

GP fund-holding would be abolished. But family doctors would be drawn into joint commissioning agencies with merged health and family health service authorities - on the lines of experiments already underway in the NHS.

The present competitive contracting system would go, David Blunkett, Labour's health spokesman, said, to be replaced by rolling 'service level agreements', probably for three years.

Some money is likely to be held back centrally to reward hospitals that outperform in a year, with extra resources provided in the following year as a reward for those that do well.

As a preliminary to phasing out pay beds, Labour would restrict their numbers, abolish tax relief on private health insurance, and consider a levy on all private treatment to recoup NHS training and other costs, while 'sensible restrictions' on the amount of private work consultants and other NHS staff can do will be examined.

The paper, Health 2000, published yesterday, provides Labour with an alternative health policy for the first time since the 1992 general election, when critics accused it of ambiguity and lack of clarity over what it would do to the Government's NHS changes.

Some of that charge will remain as details of how the new service agreements would work, how the new hospital boards would function, and how far planning would entirely replace competition are lacking. Such details could profoundly affect the outcome.

The document is consultative, but there was difficulty in interpreting it. Ray Rowden, director of the Institute of Health Services Management, said Labour appeared to be 'keeping some of the better elements of the NHS reforms' without creating 'another massive organisational upheaval that the service would groan at'.

Chris Ham, Professor of Health Policy and Management at Birmingham University, said Labour's plans would mean 'radical change to the structure and management of the health service' with the abandonment of effective competition.

To make the new-style health authorities accountable, Labour's options include continuing nomination of members, direct election, or integration with local government.

Labour would also restructure prescription charges, aim to reintroduce free eye tests, and 'consider' restoring free dental check-ups.

Leading article, page 17