Blair's legacy: Health

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By Nick Triggle Health reporter, BBC News Waiting list have been reduced under Blair's prime minister shipOn the eve of the 1997 election, Tony Blair famously told voters they had 24 hours to save the NHS.

So did the patient survive?

Yes, but not in the way he or the public probably imagined.

Blair's first health pledge was to reduce the hospital waiting lists in England by 100,000.

It was duly achieved, but the government was soon accused of ignoring the most urgent patients just to drive down numbers.

The difficulty for the government is that public expectations have been so high Professor John Appleby, King's Fund

Labour attempted to answer the critics with the 2000 NHS Plan which introduced waiting times for England - Scotland and Wales have both followed their own paths after devolution.

In 2007, no one is waiting longer than six months for non-emergency treatment - down from between 18 months and two years for some surgery in the early days. By next year no one should wait longer than 18 weeks.

But throughout recent years, government targets - including those for waiting and A&E treatment - have been attacked for distorting clinical priorities.

Problem

Jonathan Fielden, chairman of the British Medical Association's (BMA) consultants committee, said: "The biggest problem is that the government has not engaged with doctors.

"They have imposed these targets from the centre which have interfered with clinical judgement."

Early in Blair's second term, Gordon Brown announced a five-year programme of record funding to bring health spending up to top European levels.

The annual increases of over 7% until 2008 will mean the NHS budget will have tripled since Labour came to power.

KEY HEALTH DATES December 1997 - New standards of treatment under national service frameworks and the establishment of NICE to advise on new drugsJuly 2000 - NHS Plan sets out an ambitious 10-year programme, covering everything from hospital food to waiting timesNovember 2001 - Five-year spending plan to bring the NHS budget up to top European levels by 2008April 2002 - Report by ex NatWest boss Derek Wanless recommends trebling health spending by 2022, and more nurses and doctorsFebruary 2004 - Second Wanless calls for a step-change in culture towards preventing ill-health, rather than treating itNovember 2004 - Public health white paper sets out a range of measures, including a smoking ban and crackdown on junk advertisingJanuary 2006 - Ministers unveil plan to move care away form hospitals and into community

But just as with targets, the progress is open to attack.

Many have accused the NHS of becoming less productive.

Professor John Appleby, chief economist of the King's Fund health think-tank, said: "Productivity is a tricky one. The true answer is that we just do not know.

"What do you measure? Patients being treated, the success of their treatment or their qualify of life afterwards?"

The government, while questioning the maths behind critics' claims, points out that policies are being introduced to make the NHS more efficient.

The central theme of many of the reforms have been to make the health service more "patient-centred", which some have interpreted as the reintroduction of the dreaded Tory NHS market.

From the beginning of 2006, patients have been given a choice of hospitals for treatment.

The government is also phasing in a new system of funding for hospitals so that they will be paid per patient treated, rather than getting lump sums based on past activity.

Deficits

Use of the private sector is also increasing, and NHS managers are being encouraged to shift more care out into the community via specialist GP services.

However, Hamish Meldrum, chairman of the BMA's GPs committee, believes the vision is "confused and contradictory".

"Ministers are encouraging competition between different providers while at the same time calling for an integrated approach between social services, GPs and hospitals."

And the NHS Confederation, which represents health service managers, has complained that the pace and variety of change has caused unnecessary "volatility".

I feel sorry for Blair, but the money has been wasted Joyce Robins, of Patient Concern

A third of trusts failed to balance the books in 2005-6, leaving the NHS with a deficit of over £500m.

The situation has led some NHS trusts to close wards, freeze recruitment and delay operations.

Latest figures show the health service is getting back into balance, but only after holding back money from front-line services and raiding public health and training budgets.

Critics have been particularly disappointed by the public health spending cut backs after the fanfare of the 2004 white paper, which made the case for the smoking ban coming into force later this year.

Others see it from the opposite point of view. Henry de Zoete, heath researcher at the centre-right Reform think-tank, said: "The problem stems back to not introducing the reforms quick enough. We need more of it and we needed it sooner."

But from either side of the argument, there is an interesting paradox.

No government has ever invested more in the health service than Labour under Blair and yet the NHS is mired in deficits with patients taking to the streets to prevent the closure of their local hospitals.

Money

Joyce Robins, of Patient Concern, said: "I feel sorry for Blair, but the money has been wasted."

This seems to be the crux of the issue. The public was promised record amounts of money would flow into the NHS. And so it has.

But the problem is it has not necessarily gone where many would expect.

Once pay hikes - consultants and GPs have both received lucrative increases - covering for deficits and rising drug costs are taken into account, the 7% budget increases actually equate to about 2% for services, according to the King's Fund.

Surveys have repeatedly shown that when asked what they think of the NHS people reply it is in crisis.

But if the question is rephrased along the lines of what is your own experience of it they are often positive.

Professor Appleby said: "The difficulty for the government is that public expectations have been so high."