Page last updated at 10:40 GMT, Thursday, 20 May 2010 11:40 UK

NHS revamp to 'push up standards'

By Nick Triggle
Health reporter, BBC News

Hospital nurse
The government wants to drive up standards

The coalition government has promised to revamp the health service in a bid to "drive up standards".

The policy document, which covers this parliament, promises to give people choice over which GP they want.

A special fund will also be set aside to pay for cancer drugs patients are struggling to get prescribed.

The coalition document also revealed it would set up an independent board to run the health service, while patients will be directly elected on to trusts.

This reflects a merging of policies as the Conservatives had championed the independent board - to allocate funds and advise local managers - while the Liberal Democrats wanted public representation on primary care trusts, which manage local services.

However, the document promised no top-down reorganisations - the number of health authorities and trusts has been changed three times in the past decade.

Interest to patients

But it is the measures directly affecting front-line services which will be of most interest to patients.

• It seems likely some of the A&E units and maternity wards earmarked for closure will be reviewed after the document promised to stop the "centrally dictated closures".

• Patients are also to be given choice over which GP they want to register with. This is something all three parties were keen on and comes after suggestions doctors operate "gentlemen's agreements" by refusing to take on patients from other GPs' lists.

• A single urgent care number will be introduced. This is designed to relieve the pressure on A&E services during out-of-hours in particular. It will allow patients with non-life threatening conditions and injuries to contact GPs, walk-in centres and pharmacy services.

• A cancer drugs fund - trailed by the Tories before the election - will be established from savings made by stopping the rise in national insurance employer contributions. The aim is to allow patients backed by their doctors to access drugs that they cannot get on the NHS.

Nick Triggle

By Nick Triggle, health reporter

It is not so much what is in the coalition policy document, rather what is not. The government was always going to struggle to agree on every aspect of policy and health is no different.

Tory and Lib Dem health spokesmen - Andrew Lansley and Norman Lamb - spent the election campaign clashing over everything from social care to targets.

The Lib Dems were much closer to Labour on those issues and it seems the gap has proved unbridgeable - at least for the moment.

The two parties were miles apart in regards to social care and this has been effectively parked with the parties promising to set up a commission to look at the issue.

But for those working in the field that will sound like a case of déjà vu as Labour set up a similar group in the late 1990s and still failed to reform the system before their 13 years of power ended.

In the NHS, the number one concern is cuts. And while it is easy to promise saving A&Es, giving choice over GPs and setting up a cancer fund, the question still remains - how will the government pay for all this?

Nigel Edwards, of the NHS Confederation, which represents managers, said: "We have an interesting combination of Lib Dem and Conservative policies which in the long-term can make some radical changes."

The document also gave details of where the government was aiming to save money in the health service.

It said the number of quangos would be "significantly cut" and the cost of administration reduced by a third.

However, staff on the front-line warned earlier this week that the savings being talked about - £20bn over three years - would make it inevitable that doctors and nurses would be hit and patient care suffer as a result.

These savings are needed despite the government promising to raise the budget above inflation - the NHS needs more money just to stay still because of rising demands from the ageing population, price of drugs and lifestyle problems such as obesity.

However, the document also reveals some of the areas where firm agreements do not seem to have been possible.

On social care, a commission has been promised to look at how the system is funded.

It will report within a year and comes after the Tories backed a voluntary insurance scheme, whereas the Lib Dems preferred universal payments, saying experience showed opt-in schemes were "unworkable".

In the lead up to the election, the Tories had also promised to end the target culture created by Labour.

But the document makes no specific promises on this, just saying that the government will seek to measure "health results that really matter".

There was also very little detail about public health. The Tories had wanted to rebrand the Department of Health the Department of Public Health, while the Lib Dems had championed minimum alcohol pricing. Neither of these are in, although there is reference to tackling cut-price selling of booze.

But Health Secretary Andrew Lansley said: "This document sets out a clear message to the NHS.

"That our united vision is for a healthcare system which achieves outcomes that are amongst the best in the world, and free from day-to-day political interference."

Professor Chris Ham, of the King's Fund health think-tank said the agreement was "good news".

But he added: "Nevertheless, the NHS still faces a productivity gap if it is to maintain quality and avoid cutting services.

"Ministers and NHS leaders will need to take very difficult decisions in the months and years ahead, and it will be critical that they maintain an honest dialogue with the public."

Dr Hamish Meldrum, of the British Medical Association, said: "Enabling patients to register with any GP practice they want will, in reality, be very complex, potentially more expensive and could threaten that important relationship between a doctor and his or her patients."

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