The health secretary is back from holidays. A month has passed since the government's national plan for the NHS was published. Given the frenetic activity in the four months leading up to the launch, it would be understandable if Alan Milburn felt he could afford to relax. He cannot. Momentum must be maintained if the radical restructuring of the service is to be achieved. The launch was a major success - impressing both the public (see Labour's rise in the opinion polls) and the practitioners with whom ministers sensibly worked so closely. A score of leading health professionals signed up to the plan's core principles. It was George Alberti, president of the Royal College of Physicians, who declared: "This is a once-in-a-lifetime opportunity - let's grab it." Christine Hancock, general secretary of the Royal College of Nursing, wisely noted: "We're optimistic because every good idea in the plan is already happening somewhere in the health service. These ideas work and with the right support and opportunities, nurses and doctors will turn them into a reality for all patients."
The most vocal professional objections have come from the British Medical Association, which although sympathetic to the broad thrust of the plan, is adamantly opposed to a ban on private practice for the first seven years of the appointment of new consultants. Medics say there had been no mention of this reform in earlier discussions, but this is disingenuous. Ministers made it clear they wanted to "revisit the 1948 settlement", under which Labour only won the support of consultants for the NHS by "stuffing their mouths with gold". They were allowed to continue their private practice while in the public service. The gold flow continues with consultants adding £700m a year from private practice to their £1.6bn NHS salaries.
Ministers were right to propose the restriction. Private practice produces perverse incentives not to tackle waiting lists: the more people on the list, the more private practice. Take the case of orthopaedic surgeons, where there has been a 50% increase in numbers (from 678 to 1,023) but a reduction in their productivity, with the average specialist now only carrying out six operations a week. The waiting list stands at 250,000. If each of the existing surgeons did one extra operating list (half-day) a week, that would be the equivalent of 250 extra surgeons. There have been reports ministers are ready to compromise on this proposal. They should hold firm. They even have the support of the president of the Royal College of Surgeons.
Where critics have a more genuine grievance is the disproportionate increase in consultants (up 30%) compared to GPs (7%). These numbers need some reshuffling. Nine out of 10 people who use the NHS, never get to hospital. The best way of consolidating the support of managers, would be an early "earned autonomy" decision - the promise to relax central controls on successful units.
The most serious defect in the plan is its rejection of free personal care of people in long-term care, as proposed by the royal commission. They will receive free nursing care, but personal care (bathing, feeding, dressing) will be means-tested. It will be free for patients in hospital, but not for patients in residential or nursing homes. This will only create another lottery for the elderly as different homes define nursing care in different ways. Ministers cannot really believe that we can no longer provide the free bath we once offered to people too frail or ill to look after themselves? They should think again.
