Bottomley calls for `strategic oversight' in NHS of future

An easing of the turmoil in the NHS market was called for yesterday by Virginia Bottomley, Secretary of State for Health, in her most comprehensive overview yet on the state of the National Health Service.

In what is widely seen as her "swan-song" before a summer Cabinet reshuffle, she claimed the Government's NHS reforms had delivered the framework for "continuity and change" into the 21st century.

But she underlined that while the market had brought big benefits to the NHS, a role remained for planning.

The NHS required "a long-term and strategic view" she said in a lecture to the Royal Society of Medicine. "A great deal can and will be achieved through the purchaser-provider system." But as it matures, "I want to see purchasing become more sophisticated. I want to see greater use of longer-term contracts between health authorities, fundholders and NHS trusts".

That marks a convergence of view with Labour and the Liberal Democrats, who have criticised both the short- termism and the volume of paperwork involved in having only one-year contracts in the NHS market.

And Mrs Bottomley emphasised that the NHS still required "strategic oversight". There were, she said, "many issues - the training of doctors and nurses, the siting of national and regional specialities, the development of our research strategy - where it is important to take a broad view".

The new cancer strategy, where services are to be concentrated in centres of excellence to improve survival rates, "is just one example of where we shall achieve a long-term goal by working together within the framework offered by the new NHS".

The legislation now going through Parliament abolishing regions and merging district and family health authorities marked the end of an era, she said. It was "the end of structural change" after the five years of organisational tumult that the NHS reforms had brought.

Her speech was welcomed by Dr Sandy Macara, chairman of the council of the British Medical Association, who said she was "beginning to say the kinds of things we have been wanting her to say for some time". He hoped she remained in her post after the reshuffle.

Announcing a 10 per cent increase in medical student numbers by 2000, Mrs Bottomley predicted that a better- educated public, improved research, new treatment guidelines and more effective purchasers will lead to significant changes in clinical practice.

as less effective treatments are dropped.