Blair throws down challenge to GPs over NHS changesBMJ 2000; 320 doi: https://doi.org/10.1136/bmj.320.7238.824 (Published 25 March 2000) Cite this as: BMJ 2000;320:824
Blair demands reform of the NHS
Linda Beecham BMJ
The prime minister, Tony Blair, set five challenges for the NHS the day after the chancellor of the exchequer announced an extra £2bn ($3.2bn) for the service in the United Kingdom.
In the partnership challenge, the prime minister firstly wants all parts of the service to work together to end "bed blocking," reduce unnecessary hospital admissions, and provide the right number of beds and services for each level of care.
Secondly, in the performance challenge, by using information, incentives, and inspection, all trusts and primary care groups will have to reach the standard of the best, and systems will need to be in place to identify and root out poor clinical practice. As a first step, £600m of the extra money would be allocated immediately to this task.
Thirdly, Mr Blair challenged the professions to get rid of unnecessary demarcations, introduce more flexible training and working practices, and ensure that doctors do not deal with patients who could be treated safely by other healthcare staff.
Fourthly, hospitals and primary care groups had the primary care challenge to ensure that they adopted best practice so that patients with the most serious conditions were treated quickly and no one had to wait too long for an operation they needed.
And finally, Mr Blair threw down the challenge on prevention. He wants healthcare workers to adopt a more systematic approach to treating people at risk of chronic disease and to persuade people to adopt healthier lifestyles.
A dedicated unit, led by a health minister and a key leader in the NHS, will be set up for each of the five challenge areas. In addition, there will be a new Cabinet committee, chaired by the prime minister, to agree and monitor the improvements that people can expect by the end of the financial year 2003-4. The first minister in Scotland and the first secretary in Wales will join Mr Blair in a UK-wide group of ministers to drive through the reforms.
Over the next few months the prime minister and the health secretary, Alan Milburn, plan to consult the leaders of the professions and NHS organisations and talk to people responsible for healthcare provision. A detailed four year action plan for the NHS will be published in July.
The challenges have been generally welcomed. The King's Fund's director of corporate affairs, Ian Wylie, said: "The government has created an ideal opportunity to set out a national statement of values for the NHS, with which to inform the inevitable tough decisions about what the NHS can and cannot provide for citizens."
Dr Ian Bogle, chairman of the BMA council, said that the association looked forward to working with the government on planning credible changes in health service delivery and welcomed the injection of new cash. But, he said: "Difficult decisions will still have to be made on deciding priorities in the health service."
The chief executive of the NHS Confederation, Stephen Thornton, said that each of the five challenges "relies on changing clinical practice, which will need a style of working which wins hearts and minds, not naming and shaming." He said that, although there was much clinical excellence in the NHS "there are still too many clinicians who regard moves to improve standards as unwarranted interference."
The full text of Mr Blair’s speech is at www.publications.parliament.uk/pa/cm199900/cmhansrd/cm000322/debtext/00322-04.htm#00322-04_spmin0
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