Tories lambast policy 'shambles'

The Labour Party's health plans were launched to a vitriolic attack from the Conservatives but to a generally warm welcome from those who will have to put them into effect.

GP fundholders, predictably, were most hostile. But Dr Howard Freeman, treasurer of the National Association of Fundholding Practices, pointed out that while the Labour Party spokeswoman on Health, Margaret Beckett, had said fundholding would end, the document, despite its hostility to the idea, did not contain an absolute commitment.

"I think there is room there for practice-based purchasing to be retained," he said. "I certainly hope so".

Others raised reservations about particular items. But Philip Hunt, director of the National Association of Health Authorities and Trusts, said: "It is clear that they want to build on many of the best features in the current NHS."

Ray Rowden, director of the Institute of Health Services Management, said "There is a lot of flesh to be put on the bones, but I think most managers will have no problems making the proposed system work, and work well."

Rodney Walker, a pioneer of the reforms under the Conservatives, praised Labour's "sensible approach" on behalf of the NHS Trust Federation. Trusts "did not feel threatened" by the proposal to widen their board membership.

Mr Rowden, however, warned against proposals to put health professionals as of right on Trust boards and health authorities. "To release that sort of tribal representation again will lead to a confusion of roles. It should be avoided," he said.

And Mr Hunt said that if fundholding were abolished, "it remains essential that GPs retain a prime influence. We want to see them as the power-brokers of the system."

Some leading academics questioned whether GP commissioning will be more than a talking shop. One said: "The crucial question remains: 'Who controls the budget?' It is control of the budget that has made fundholding so powerful."

The British Medical Association said the document was short on detail, but the health service union, Unison, said Labour was proposing "workable changes that will not lead to disruption".

But Virginia Bottomley, the Secretary of State for Health, said: "No- one should be fooled by Labour's claim to want to keep a form of purchaser- provider system. Key incentives to improve performance would disappear. Only Labour would try to ride a bicycle with the cogs in place but no chain." The proposals were "a shambles of a policy which would set the NHS back a dozen or more years".