The King's Fund message to new health secretary - don't falter now on radical vision for health

The government must press ahead with reforming the National Health Service and resist the temptation to hold back on a radical vision for health during its third term.

That was the call from The King's Fund today by the health charity's chief executive Niall Dickson.

In a keynote speech at the Royal College of Midwives' annual conference in Harrogate he said:

'The government is right to pursue a radical agenda. We have seen the start of some significant improvements to the health service in England. But there is much more to do and if services are to become more responsive we need both stronger incentives at local level and less central control.

'The introduction of new funding arrangements whereby hospitals and other services are paid for the treatments they deliver is the right approach. Likewise giving those who use services more choice about where and how they are treated must be the way forward. But there are clear challenges ahead.

'The economic regulation of the new market developing in the NHS needs much more work - if services are not delivering patients should not suffer. We have to avoid unnecessary financial instability, but accept that the pattern of services will change.

'Secondly the government must get to grips with the whole area of commissioning services which remains the Achilles heel of the health service.

'And on top of this we have to make sure that patient and maternal choice enhances and does not jeopardise equity.

'We recognise the current experiment with a more market orientated system carries risks, but we advise Ministers to keep faith with the new incentives and refine them where necessary. Going back should not be an option.'

In the run up to the election The King's Fund called for action in six of the most critical areas facing the NHS:

Managing the new NHS market: Ministers must address potential problems associated with the introduction of stronger market incentives to the NHS. New reforms such as 'payment by results' and patient choice, while welcome, threaten to create a less stable health economy that could destabilise services. Urgent work is required to set out plans to oversee the new market; for example, having clear policies on how financial failures of hospitals should be managed, while protecting vital local services. Action is also needed to ensure patients have access to a comprehensive range of services and that all patients - particularly the most disadvantaged - are able to make choices.

Commissioning: this crucial area remains a problem for ministers. The King's Fund strongly supports moves to devolve power to the NHS front line by handing family doctors their own budgets to commission services. This should help to increase the influence of front-line clinical staff and make the NHS more responsive to the needs of patients. But while devolution may well be a good thing, unfettered devolution could be a disaster as there are dangers with moving from a highly managed system to a barely regulated market. Careful thought will need to be given to how the market will be regulated, while the right relationships between primary care trusts (PCTs) and GP practices are crucial to ensuring family doctors enjoy appropriate freedom while still receiving strategic direction from PCTs.

Ending waiting times: the NHS has been set ambitious targets to reduce waiting times for operations. If these are to be achieved, the Government needs to invest heavily in diagnostic staff and equipment, more doctors, nurses and allied health professionals and make greater use of the independent sector.

New focus on 'forgotten' areas: mental health, the care of older people and improving care for the 17 million people in the UK with long-term conditions have traditionally been neglected - although the King's Fund welcomes the improvements that have been made. The Government must now focus more heavily on helping people manage their conditions more effectively in the community so they do not need expensive and disruptive hospital treatment.

Public health: the government faces a significant public health challenge with rising levels of obesity, diabetes and sexually transmitted infections, as well as increased problems of drug and alcohol abuse. To meet these challenges, the new Secretary of State for Health should use the expected Public Health Bill to reconsider opting for a full ban on smoking in all enclosed public places, be prepared to look again at the decision to extend alcohol licensing hours and have the courage to ban junk food advertising to children. Ministers should take a stronger stand on ways to use regulation, especially if industry fails to take voluntary action on issues such as food labelling.

Notes to editors: 

1. For further information or interviews, please contact The King's Fund media and public relations office on 020 7307 2585, or 07831 554927.

2. Niall Dickson was speaking at the Royal College of Midwives' plenary session on influencing health systems, which was chaired by Ruth Clarke, Chair of the RCM Council.

>3. The King's Fund recently published An Independent Audit of the NHS under Labour (1997–2005) on Sunday, 20 March. It found the government has made huge strides in reforming the health service since coming to power in 1997, but warned there are still important problems to be solved and that as yet there is no firm evidence to show the reforms have produced a marked improvement in the nation's health.

4. The King's Fund is an independent charitable foundation working for better health, especially in London. We carry out research, policy analysis and development activities, working on our own, in partnerships, and through grants. We are a major resource to people working in health, offering leadership and education courses; seminars and workshops; publications; information and library services; and conference and meeting facilities.