Blair's fresh prescription

Labour's NHS plans are on top form, says Chris Smith

In his article about Labour's policies on health ("Is the NHS safe under Dr Blair's team?", 30 October), Jack O'Sullivan accuses us of idly resting on our laurels and allowing the Tories to steal the show on health.

He clearly did not listen to the debate we had on the floor of the House of Commons on Friday week, when we put Stephen Dorrell on the spot on a series of issues, ranging from the provision of salaried GPs in inner- city areas to the dangers of commercial companies offering GP services (and in the process destroying the professional nature of the doctor-patient relationship). We are not giving the Tories an easy ride, and we intend to increase the pressure as we approach the election.

Mr O'Sullivan's principal complaint would appear to be that he detects no fresh thinking, no sign of innovation, from Labour. The NHS under Labour, he says, would not be very different from its condition under the Tories. I beg to disagree.

We don't want to overturn everything in a grand upheaval, certainly. Everyone in the health services has told us that is the last thing they want or need. But we do want to make changes, because the introduction of the competitive internal market has caused immense damage. It has set hospital against hospital, doctor against doctor. It has removed the central principle of equity of access from the health service. It has meant that decisions often have to be taken on the basis of what the contract says, rather than what is best for the patient. And it has generated enormous amounts of unnecessary bureaucracy.

Yes, we want to retain the division of responsibility between those who order care and treatment for patients and those who deliver it. That is a commonsense division; but we would want it to lead to a system based on co-operation and collaboration, where doctors, hospitals and health authorities would sit down together to agree a forward programme of treatment for their patients - not only for a year, but for several years ahead. That would transform the Tories' competitive ethos.

Two days ago, I visited Great Ormond Street Hospital to see something of the fantastic work they are doing in a highly specialised field. But in order to carry out a year's work, they must have contracts with 60 different health authorities and with 1,500 different fundholding GP practices. This is not a sensible way of delivering high-quality paediatric care to those children who need it. A competitive market system simply isn't appropriate.

It is all too easy, however, to get stuck in a sterile debate about structures. We want to move to more sensible co-operation, but we also want to move the debate about the future of health care in Britain forward. For example, we want to appoint a Minister for Public Health, working across government departments, looking at everything from the banning of tobacco advertising to the establishment of nutritional standards for school meals.

Second, we envisage the development of a recuperation service, to help people recover from major treatment in a supported environment near to their home, rather than being forced out of hospital too early. Third, our proposals for the reform of information technology organisation within the health service (coupled with the development of nationwide, broad- band communication) could enable expert medical advice to be brought directly to neighbourhood GP level.

Fourth, there is our proposal to use savings from excessive bureaucracy to fund, among other things, a reduction in waiting times for surgery for cancer - so lightly dismissed by Mr O'Sullivan.

This will not only remove an enormous amount of distress and trauma for thousands of patients, it will also change fundamentally the present government's approach to waiting-list reductions, which appears to be based simply on time rather than on need or degree of pain.

Finally, the importance we attach to measuring properly the effectiveness and quality of NHS treatment offers the prospect of achieving better value for money out of our health expenditure.

We need to recognise that health is not something that is simply dependent on good hospitals and doctors and primary care, important though these all are. Health also depends fundamentally on factors such as poverty, or inadequate housing, or a polluted environment. It is a stark statistic that those people born into the poorest tenth of the population have a life expectancy eight years less than those born into the wealthiest tenth. Inequality of income and condition has a major impact on the quality of people's health, and inequality has widened dramatically over these past 17 years. We want to begin to put that right in government.

The NHS is too important to be tossed aside in one dismissive article. It needs a change of government to take it imaginatively forward into the future.

The writer is Shadow Secretary of State for Health.