Health

Sir Peter Kemp, former Whitehall mandarin, subjects our health manifesto to a reality check

guardian.co.uk, Friday 30 June 2000 15.20 BST

The manifesto has to address tightly the value obtained from the £40bn per annum, or thereabouts, being spent, plus whatever more is going to be provided. It is crucial to recognise that merely throwing money at the system is not of itself going to engender quality or confidence.

Is health care to be localised or centralised? There is a lot to be said for localisation and some experiments here should be promised. Such a step would integrate local authority social services more closely with health services.

Centralisation, on the other hand could be made to work, if it were broad enough (and included local authority services). The manifesto should give a pointer here. Either way patient-driven better management, specified in some detail, must be promised. The role of the private sector needs clarifying. The NHS should stay free at the point of service, of course, funded by the state, but what is the public/private mix to be at the provider end?

Public health and better living must be split off from care of the sick. The manifesto should promise a "department of the individual" dealing with healthy living, food safety, some aspects of environmental concern, and appropriate other aspects of daily living. This is not just a matter for some outpost of the cabinet office; it deserves a cabinet minister in its own right.

More money should be found for residential care and the like. But there is more to the well elderly than that and there's a very wide range of needs that this particular group has, including a pensions regime. The manifesto should discuss what these needs are and how they can be met.