The King's Fund reviews five years of relentless change in health policy

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Health policy in Labour's first five years in government leaves 'an overwhelming impression of relentless, almost hyperactive intervention' says a review published today by The King's Fund.

Five-Year Health Check: A review of health policy 1997-2002, edited by John Appleby and Anna Coote, shows that the government has unleashed a torrent of new policies since 1997, trying to iron out health inequalities, raise care standards, improve NHS productivity, increase responsiveness and extend services.

The review says that the government's commitment to a national health care system available according to need and funded through taxation is 'beyond doubt'. The government has led an unprecedented drive to put more resources into the NHS, by increasing funding, tackling longstanding staff shortages and making increasing use of the private sector.

However, Labour has not yet developed a coherent and principled set of criteria to guide its decisions. Its rhetoric is often radical, but its actions, however plentiful, are essentially conservative. The government's reforms of long term care have failed to mend a rickety system, leaving both users and carers dissatisfied. It has entered into a massive hospital building programme with the private sector, without a clear assessment of how future needs will be met, and without transferring any substantial risk.

The King's Fund chief executive Rabbi Julia Neuberger said:

'As it approaches its fifth anniversary in Government, Labour has a lot to be proud of. It has shown real commitment to a publicly funded NHS and to improving people's chances of living healthily.

'But investment and reform have been a double-edged sword. The NHS is overwhelmed with well-meaning policy directives, must-do targets and structural changes. Primary care trusts in particular are struggling to meet all of the policy imperatives Labour has set them.'

Rabbi Julia Neuberger continued: 'Health policy is about nothing if it is not about improving health. If Labour really can turn around the long-term trend towards widening health inequalities, it will have made a remarkable achievement.

'But it is already evident that there are conflicting tendencies in Labour's health policies, not least those between investment in the NHS and investment in health improvement, and between central control and local autonomy. Those tensions must be resolved if Labour is to avoid storing up problems for the future.'

Five-Year Health Check reviews health policy since 1997 in 10 key areas, including NHS funding, quality assurance and the reorganisation of primary care services. It concludes that Labour has achieved some important and far-reaching reforms, not least setting up new organisations to improve the quality of care patients receive and opening up access to primary care, for example through NHS Direct.

But the review also shows serious gaps in Labour's record. Too much store has been set on structural solutions to problems caused by decades of under-investment and over-centralisation.

Five-Year Health Check finds that the government is travelling in the right direction, towards a more robustly funded NHS, improved standards of health and social care, more patient-centred services and a system that is trying to reduce health inequalities. But it has raised public expectations of the NHS, putting it under enormous pressure.

The review suggests that the government should now:

  • Keep the money flowing, but dispel any remaining illusions that money alone will save the NHS.
  • Stop the incessant flow of orders from the centre, build the morale and confidence of the workforce, and enable them to take ownership of the reform process.
  • Have fewer, broader targets for the NHS, which are costed and funded appropriately.
  • Give a higher priority to improving health and reducing health inequalities.
  • Prepare the public for the long haul: stop making heroic promises and buckle down to the unglamorous detail of building a good-enough health system for the 21st century.

Notes to editors

Five-Year Health Check: A review of health policy, 1997-2002, edited by John Appleby and Anna Coote, is available from The King's Fund bookshop on 020 7307 2591, price £7.99. It includes chapters on: 

  • Funding 
  • Waiting 
  • Rationing 
  • Primary care
  • Workforce 
  • Quality assurance 
  • Private sector
  • Long term care
  • Patient and public involvement
  • Health inequalities

For review copies of Five-Year Health Check or interviews with the editors, please contact Andrew Bell on 020 7307 2585 or 07831 554931, or Daniel Reynolds on 020 7307 2581.