How radical are the Tory NHS plans?

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By Nick Triggle Health reporter, BBC News Over 200 targets were set by the NHS PlanWhen you consider that Labour has trebled spending on the NHS since the party came to power, it is quite remarkable in many ways that the Tories believe there is much to gain from knocking their record.

But in his speech to the Royal College of Surgeons on Tuesday, David Cameron once again reiterated that the NHS is his number one commitment.

The Tory leader was quite clear, the government had failed in its target-based approach to the NHS in England.

Ministers understandably point to the big falls in waiting times.

By the end of the year no one should wait longer than 18 weeks for hospital treatment when 10 years ago it was not uncommon to find patients waiting two years.

While there have been improvements, you have to consider the unintended consequences and distortion of clinical priorities Jonathan Fielden, of the British Medical Association

Nonetheless, targets remain unpopular.

Reports have emerged of ambulances queuing outside hospitals because A&E departments did not want to admit them because of fear of breaking the four-hour waiting target.

While patients have been left frustrated about not being able to book GP appointments in advance because surgeries have wanted to leave slots free so they can guarantee appointments within 48 hours as they have been told to.

Doctors have also voiced concerns that people needing operations are pushed ahead of more serious cases in the list just because they are close to the waiting limit.

This is supported by the fact that while the longest waits have been eradicated, average waiting has actually increased slightly since Labour came to power.

Jonathan Fielden, chairman of the BMA's consultants committee, said: "While there have been improvements, you have to consider the unintended consequences and distortion of clinical priorities."

And this is why the Tories believe there is mileage in the issue.

Major issue

They have promised to scrap them, replacing them with what they call a new list of health outcomes covering cancer, heart disease and stroke.

Mr Cameron believes this is what "really matters to people" rather than the more process-driven measures used by the government.

This has been welcomed by patient groups. Kate Jopling, of Help the Aged, said: "It's good to see the emphasis on reducing top-down targets.

"An emphasis on quality and outcomes should refocus services towards individual needs."

But this is not the first time the Tories have targeted the targets since more than 200 were set out by the NHS Plan in 2000.

It became a major issue in the 2005 general election during which Tony Blair admitted a new approach was needed as the ones used to date had been "crude".

Consequently, they are now in the process of being phased out - albeit slowly.

In their place there are now a whole series of public service agreements - agreed contracts between the Treasury and government departments.

A look at those relating to the Department of Health makes interesting reading.

By 2010, they set improvements in outcomes for a series of diseases, including cancer, heart disease and stroke.

Professor John Appleby, chief economist of the King's Fund health think tank, said: "I think everyone now agrees it is the right time to move away from the traditional targets.

"Outcomes are being looked at, but the problem is that you cannot say what the NHS is responsible for, as other factors such as lifestyle and genetics play an important role."