Dorrell points way forward for NHS

PATRICIA WYNN DAVIES

Political Correspondent

A crackdown on unnecessary operations or other questionable treatments was signalled last night by Stephen Dorrell, Secretary of State for Health.

But in a strongly "One- Nation" Millennium Lecture at the Manchester Business School, Mr Dorrell emphasised that no health authority should ration resources by ruling out clinically effective treatments.

"We must recognise in the first instance that it is a national health service," Mr Dorrell said, adding that "each health authority and fundholder must have available to them the funds which will allow them to deliver a quality of service to patients suffering from similar conditions which is broadly comparable in different parts of the country."

The remarks came with a pledge not to introduce further management upheaval in the NHS, but to concentrate on how the structures were to be used and on pursuing the development of primary care - the services offered by GP practices as opposed to hospitals.

Mr Dorrell said there were limits to the acceptable range of variations in provision within a national health service and urged health authorities and GPs to challenge "surprisingly high treatment rates where this has not been shown to deliver better outcomes".

Highlighting the "surprising" variation in the percentage of Caesarean births in different hospitals, and "ineffective" grommet operations, Mr Dorrell said he would be making clear to the new-style health authorities beginning work in April that it would be "their task to challenge such variations".

He also highlighted areas where there were variations in the rates of coronary artery bypass grafts and other similar operations. "Those health authorities with low [CABG] rates, as well as those with the highest rates, should be asking whether their use of resources reflects clinical priority," Mr Dorrell said.

The Secretary of State's concerns reflect a warning by the Commons health select committee that the delegation of health services management could lead to a patchwork system of care.

He did not rule out the "sensible" use of guidelines on the management of health provision, but emphasised that a policy that ruled out a clinically effective treatment was not acceptable.

"There should be no clinically effective treatment which a health authority decides as a matter of principle should not be provided," he said. "To ban treatment in such circumstances would be inconsistent with the principles on which the NHS is established and I do not believe that they represent acceptable practice."

Mr Dorrell's secretary's strictures appear to be intended to avoid a repeat of the furore over the refusal to treat the leukaemia patient, Child B, on the national health.

Spotlighting his commitment to developing primary care, he warned health authorities and GP purchasers to "ensure that priorities are not distorted in favour of the hospital service".

Gerry Malone, the Health Minister, would lead an examination of the options for the development of primary care, Mr Dorrell said.

t Sign-on fees of up to pounds 2,000 are being offered by hospitals increasingly desperate to recruit nurses with specialist qualifications, writes Barrie Clement.

The lump sums are being paid at a time when nine out of ten National Health trusts are reporting shortages, especially in paediatric departments, intensive care and operating theatres. The trend is revealed in a survey conducted by Incomes Data Services which found that around 15 per cent of trusts were offering some sort of added inducement.