Labour pledges to renew NHS at 50th birthday party
Tony Blair gave a rousing speech to delegates at the NHS Confederation’s celebration of the 50th birthday of the NHS, sounding a note of reform as he attacked the internal market for “doing great damage, often undermining the values of the NHS”. He hinted at the three year `Modernisation Fund’ plan of extra capital confirmed later, but also laid down a challenge to managers that “no vested interest conservative instincts should stand in the way of doing things differently. That’s the deal”. He also said that trusts chosen as “beacons” for the rest to follow would be given extra help.
Reactions to the Prime Minister’s speech at the conference ranged from the laudatory to the sceptical. Stephen Thornton, chief executive of the Confederation, told a press conference that he welcomed the speech, especially the “beacons” idea, saying “we need more celebration of good practice”. However he added that there seemed to be “a danger of too much ‘topdown’ – too much emphasis on compliance”. On the quality targets raised by the government’s new White Paper A First Class Service – Quality in the New NHS, he wondered “how do we identify best practice re quality?”. Karen Caines, chair of the Institute of Health Services Management, welcomed the increases in capital promised, but warned that the NHS “will need more – we’ve identified that a 4% year-on-year increase is needed”.
Dobson’s speech was a firm affirmation of the value of a publicly-funded NHS, that flew in the face of reformists who would wish to make sweeping alterations to the long-standing culture of the NHS. “The NHS has proved to be the cheapest and most cost-effective health care system in the developed world,” he said. “It avoids the costly paperwork that’s inevitable in any system where patients have to pay”. Dobson laid down the gauntlet to delegates that “may want to discuss the far blue yonder of alternative health care systems,” saying “this Government is committed to the one we’ve got”.
In a satellite session on PFI, the NHSE director of finance and performance Colin Reeves admitted that the publication of new PFI standards had been delayed, and also expressed the common concern that PFI schemes were replicating old models of health building. He told delegates: “The worry I have had for some time is that under PFI we do seem to be recreating the DGH concept of the 60s people say they aren’t flexible and adaptable”. However he did say hopefully that “there is still very much a role for exchequer capital…the Secretary of State wants a balance between EFL and PFI”. Reeves added however that the Department of Health is “keen to use design and build as the model for exchequer schemes, and to move away from flexible contracts to fixed price”.
He said the focus of the new guidance would include more emphasis on the operating side of DBFO contracts and affordability, with adaptability of design a major factor. He said it would be released “very soon” after the forthcoming Government review of PFI, and warned also that a consultation “protocol” was forthcoming that would require documents on PFI schemes to be published, to achieve “greater sharing than in the past”.
Lastly, under questioning Reeves said that “there was an implicit view at the Treasury that the minimum cost limit before going to PFI should be raised”.
Copyright Wilmington Publishing Ltd. Aug 1998
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