NHS `facing a stark choice'

PUBLIC HEALTH

A new public health agenda - including a ban on tobacco advertising and a Food Standards Agency independent of the Ministry of Agriculture - was promised yesterday by Tony Blair to go with a renewed "vision" for the National Health Service.

But while he pledged an end to the erosion of the NHS which, he said, has forced more and more people to go private, and while he promised more "co-operative" and "flexible" commissioning in place of the internal market, he made clear there would be no early extra resources for the service and he provided no new detail on how Labour's changes would work.

In a speech to the National Association of Health and Authorities and Trusts in Harrogate, North Yorkshire, Mr Blair said the service faced a "stark choice". It could continue down the road towards a scaled-down service in which people increasingly lost faith and reached for their cheque-books to pay for private cover. If that continued, "I genuinely believe that the NHS would cease to exist as we know it."

Or it could become a modernised service providing the "quickest and best" as part of a broader health policy which would include a tobacco advertising ban, a Food Standards Agency fiercely on the consumer's side over food safety and labelling, and a Minister for Public Health charged with Whitehall- wide action to reduce health inequalities. Early action in the NHS would include a task force aimed at ending the scandal of trolley waits in accident and emergency departments, and making sure the NHS can cope with rising emergencies.

"I do not see that people should have to wait on trolleys for hours in a modern NHS," he said. Admission wards, the diversion of some managers into bed management and greater responsibilities for nurses would also help.

But many of the changes needed did not necessarily require extra resources, Mr Blair said. He warned that Labour would have to see whether existing budgets were well spent, and that cash was not being wasted on ineffective treatments, before it would examine "whether there was still a funding gap that needed to be bridged".

Patients would expect Labour to work faster in weeding out ineffective treatment and ensuring the treatment that is provided is clinically proven, he said.

While repeating Labour's promise to wind up GP fundholding, his message otherwise was one of stability - "practical reform, not upheaval based on dogma". Labour's priority would be "to make changes that are in the interests of patient care and not start making organisational change where it is not needed". Change would not be foisted on the NHS without consultation, he said.