Election '97: HEALTH: New food safety agency but little reform of NHS

Labour's watchwords are caution for the National Health Service and radicalism for public health. It is going to refine and improve the NHS internal market but tackle the food and tobacco industries head on.

A headline in the manifesto proclaims that Labour will end the Tory internal market, but a close reading of the detail suggests it will do no such thing. Out goes the purchaser-pro-vider split, but in comes the planner- provider distinction ("the planning and provision of care are necessary and distinct functions, and will remain so", the manifesto says).

Out goes the small GP fundholder (though the manifesto does not categorically say it will be abolished) and in comes joint commissioning, in which "GPs and nurses will take the lead in combining together locally to plan local health services". Out will go one-year contracts between GPs and trusts; in will come three- to five- year agreements. The system should work better, but will not be a thousand miles away from the present set-up.

What the party lacks in radicalism for the NHS, however, it makes up for by its policies on public health. It promises to ban tobacco advertising (to cries of joy from the British Medical Association, which has campaigned to this end for many years); set up a new post of minister for public health; and establish an independent food standards agency, to remove responsibility for food safety from the Ministry of Agriculture, Fisheries and Food, which is seen as too closely allied to the farming lobby.

On the issue of resources, it promises to raise spending in real terms every year, but "to spend the money on patients not bureaucracy". In favouring doctors and nurses over bureaucrats, Labour is of course repeating the mantra of all poli- tical parties (one cannot wait to see a party with the slogan: "more power to the pen-pushers"), but it can do so with a little more conviction than the Tories, who showed astonishing chutzpah yesterday in proclaim-ing their spending had always concentrated on "priorities, not wasteful bureaucracy".

The first pounds 100m saved from running the internal market, will be put into patient care, to end, in particular, all waits for cancer surgery, it says.

Other imaginative, though secondary pledges, include: eliminating mixed- sex wards; promoting new developments in telemedicine, so expert advice is brought from regional centres of excellence to neighbourhood level; and measuring the quality of outcomes from hospital treatment, rather than merely the quantity.