Did the NHS Plan actually deliver?

MPs are investigating the impact of the landmark roadmap for the NHS. Tom Ireland reports.

In July 2000, with support from most UK health bodies, Labour's NHS Plan was published - alongside the largest sustained increase in investment in the health service's history.

Ten years on, The All Party Parliamentary Group for Primary Care and Public Health, led by practising GP and Dartford MP Dr Howard Stoate, is reviewing whether the plan was the right one and whether its objectives have been met.

A panel of high profile NHS leaders from then and now were invited to give evidence in parliament last week.

Some revealed they had been wary about signing up to the NHS Plan at first. DoH national director for A&E, Professor Sir George Alberti, one of the original signatories as president of the Royal College of Physicians at the time, backed it only at the last minute after checking final details.

'The final copy was written on the night by secretary of state Alan Milburn and one of his shadowy advisers, and I refused to sign it until I had seen that final copy,' he said.

But Christine Hancock, now chief executive of Oxford Health Alliance, a charity set up to tackle global health issues, said she fully supported the plan as general secretary of the Royal College of Nursing in 2000.

'The policy is rarely a problem. It's the implementation that is always a problem. The plan was quite robust but there are questions over what has happened since,' she told MPs.

Cash injection
Despite the huge injection of funding, which has delivered clear improvements in the NHS, several speakers said key objectives had been missed.

BMA chairman Dr Hamish Meldrum believed only the massive growth in funding saved the plan from counterproductive DoH policies that followed.

'The increase in funding has had more effect than anything else. Organisational changes have got in the way of some the better things in the plan.'

Funding has not always been targeted at those who need it most, he argued. 'We have concentrated on access and choice, for people who perhaps are not particularly unwell.'

RCGP chairman Professor Steve Field cited polyclinics as an example of how the DoH had turned its back on the plan's promise of a 'patient-centred' NHS.

'We have seen PCTs not responding to the needs of patients - with the imposition of "Darzi centres", despite the opposition of the public and local GPs,' he said.

Shifting services from secondary to primary care was another unfulfilled pledge set out in the NHS Plan, the panel said. Mike Farrar, chief executive of North West SHA and former DoH director of primary care, warned funding was not moving into primary care from secondary care fast enough to cope with the growing burden of public health.

'If we do not get primary care capacity up, we will build up so much more demand for healthcare that we will have to increase capacity in secondary care all over again.'

There was a consensus among those giving evidence that PCTs had failed to use enhanced services to commission secondary care services from GPs effectively.

Public health concerns
Public health dominated the debate about what should have been done differently in the past 10 years.

Professor Alberti said the NHS had 'totally failed' on preventive medicine and reducing demand on the health service.

Dr Meldrum called for more interdepartmental work to tackle wider social health problems that lie beyond the NHS.

Ms Hancock thought NHS Direct was the 'greatest missed opportunity' of the NHS Plan.

The panel defended the introduction of the 2004 GMS contract, which cost the DoH £1.8 billion more than it expected in its first three years.

Mr Farrar, who was involved in negotiating the contract on behalf of the DoH, said it had improved primary care. But he argued that GPs 'getting more or less the full whack' for achieving 90 per cent in the QOF may mean the hardest-to-reach 10 per cent of the population are not targeted by GPs.

Dr Meldrum admitted he was concerned that the contract did not link income to the number of GPs in a practice, meaning GPs were poorly distributed around the UK.

Professor Field said that if practice nurse training was improved and health visitor numbers were increased, much more could have been achieved in primary care.

Dr Stoate, chairing the debate, seemed most interested in calls for a new plan and a new 'secretary of state for the health of the public'. 'I rather like the sound of that,' he said, committing to take the idea forward.

The All Party Parliamentary Group will produce a report on 14 July on how the NHS Plan can be 'tweaked', said Dr Stoate.

tom.ireland@haymarket.com

What the NHS Plan promised

  • Reduced waiting times and patient-centred care.
  • Modern, quality-based contracts for GPs and doctors.
  • Increased capacity in the NHS by use of the private sector.
  • 48-hour GP appointments by 2004.
  • Regular inspection of all health bodies.
  • More and better paid NHS staff.

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