May 1, 1998

Tony Blair's government is one year old today. What challenges lie ahead, what has it achieved so far and, if Labour celebrates ten years in power, how will Britain look in 2007? The experts give their verdicts.

Secretary of State Frank Dobson has been remarkably successful in extracting additional resources from the Treasury, first for the "winter bed crisis" and subsequently to reduce waiting lists. The latter is a political priority but is not the best use of taxpayers' money. The Labour election poster pledge to reduce waiting lists and waiting times for often relatively minor procedures contributes less to the health of the population than investment elsewhere (mental health care).

The government's proposed "redisorganisation" of the NHS is strong on presentation but weak on substance. The decision to abandon the Tories' internal market and replace it with "command and control" management may produce conflict with the medical profession. The government plans to create a National Institute for Clinical Excellence to generate a core curriculum of evidence-based treatment guidelines and a "hit squad", the Commission on Health Improvement (Chimp), which will sort out doctors who monkey about. Doctors, like academics before them, need to be managed but hopefully in a way superior to that evident in universities.

Health in 2007

The future of the NHS is tight cost control, improved information technology and more rigorous management. There continues to be much inefficiency in the service and demands for increased spending have to be treated with caution. At worst they may merely be an attempt to keep the pharmaceutical industry and others in the style to which they are accustomed. The focus must be policymaking based on evidence about which of the variety of treatments in use work, not a mere assertion that more cash will automatically mean better health for patients.

Alan Maynard is professor of health economics, University of York.

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