An end to polls and wheezes

'It is a great pleasure to celebrate with you the 50th anniversary of the NHS. It is my purpose today to give you the results of the comprehensive spending review and to indicate the nature of New Labour's radical commitment to the NHS.

'We have been accused of following rather than leading public opinion. Nowhere is this more evident than in the area of waiting lists. Our focus groups and opinion polls show that this is the public's major concern. We will no longer tolerate this nonsense from the electorate. We recognise that such lists are the product of decisions by self-interested GPs and consultants, the former collaborating with the latter to increase their private practice income. Therefore I have instructed the health secretary to ensure that all NHS consultants are full-time employees of the service from April 1999. Consultants will, I am sure, show their true dedication to the People's NHS.

'We accept that the narrow range of activities which currently determine waiting list statistics has distorted resource allocation. It has led to underfunding of mental health services, the slothful introduction of the Calman-Hine proposals, and hidden waiting lists for radiotherapy, coronary surgery and other essential treatments.

'Of course, many of these hidden waiting lists are poorly described and measured due to the ignorance upon which the NHS flourishes. It is amazing how well the service performs when there is no information about most of its activities. We intend to invest pounds3-5bn in information technology over the next five years. And, as in the private sector, we recognise that there may be some mistakes in this ambitious programme - we ask the health select committee and the media to be tolerant and supportive of our endeavours.

'We have also made mistakes, which we now intend to reverse, about hospital closures and mergers. The health secretary will today announce the closure of St Bartholomew's Hospital, as our previous policy distorted London's healthcare system. Our merger policy will now be based upon evidence rather than local advocacy by the party faithful. The optimum size of a hospital is around 600 beds for a population of 350,000.

'Proposals to create primary care groups have raised some opposition from the profession. It is our intention to manage the general medical services budget rather than leave its use to the machinations of a group of noisy and self-interested shopkeepers. As we rattle the wallets of GPs, we intend to progress to a salaried service with equalised resource allocation and detailed clinical governance procedure.

'Our innovative development of health action zones will be led by large, salaried primary care groups, one of whose roles is to increase the use of the NHS by the poor. It is no longer acceptable to have poor quality primary care in areas where excluded populations live. The failure of previous governments and the Royal College of General Practitioners to tackle these inequalities is lamentable: royal college privileges are not given to succour the middle classes alone.

'The royal colleges have one last chance to work with managers and government to enhance clinical governance. We note the pathetic use of substantial investments in clinical audit. The failures of clinical audit must not be repeated: the profession either manages the lumpen proletariat of its members or faces the consequences of outside management. If the colleges fail they, like other failing medical charities, will lose their tax-exempt status. Why should the taxpayer subsidise indolence and inefficiency?

'The lessons from clinical audit will help design the National Institute for Cost Effectiveness (previously known in error as the National Institute for Clinical Excellence). The profession's failure to embrace evidence- based and efficient care in guidelines, protocols and audit means that, although medics will have significant inputs into NICE, it will be governed by non-doctors, such as statisticians and economists. If the profession fails to collaborate or tries to dominate the work of NICE, appropriate action will be taken.

'We intend to fund the ambitious hospital building programme out of public funds, as private financing has proved expensive and slow. However, we encourage evaluated experimentation with public and private management setting standards so that public squalor in the NHS is eradicated and private affluence emulated.

'Finally, we intend to increase NHS funding by pounds2bn annually. Let me be honest about this funding. In early 1998 we agreed with the nursing unions that a more generous settlement would be left until 1999. We are grateful for their co-operation and will reward them appropriately with gongs and similar government debris. The effect is that much of the current increase will be absorbed by better pay for nurses.

'The new NHS will be managed openly and not on the basis of polls and wheezes. We will work with you to lead the NHS not into the temporary amelioration of its weaknesses, but into carefully designed and evaluated policies that encourage everyone to make the new NHS accessible, dependable and humane.'

This is a draft speech for the prime minister to next month's 50th anniversary conference: 'We have made mistakes about hospital closures and mergers. The health secretary will today announce the closure of Bart's'