Published: 30/09/2004, Volume II4, No. 5925 Page 14 15

Today the last Labour Party conference likely to take place before the next general election draws to a close. As commentators speculate on who might lead a Labour government if it wins a third term, leading organisations influencing health policy have been busy lobbying the party on the contents of the next health manifesto.

Jack Shamash finds out what the lobbyists think and how they regard Labour's legacy to the NHS so far

NHS Confederation chief executive Dr Gill Morgan

'There is little willingness to take on big commercial organisations'

Dr Gill Morgan is in no doubt that the achievements of this government are substantial.

'There is better access to services in the acute sector and the system has become more efficient. There is lots of innovation, which is improving the NHS.'

She praises 'improved skill mixes', which allow different groups of staff to take more responsibility, and she cites examples of primary care trusts coming up with successful initiatives in which physiotherapists do orthopaedic triage and specialist GPs run urology clinics, to avoid unnecessary consultant referrals .

However, she still sees problems, in the mental health services and sexual health areas, where improvements are patchy.

She is concerned that commissioning is not effective, with often just one person responsible for all stages of planning, policy modelling, procurement and contracting. 'We need to be more sophisticated, ' she says.

Dr Morgan would like to see more power devolved to local organisations. 'The government should assume that organisations such as PCTs and hospital trusts are rational and sensible. We should encourage innovation and risk taking. We need different services in different parts of the country.'

The government should grasp the nettle and take on 'vested interests' such as drug companies and the food industry: 'Because there is no joined-up thinking, there is little willingness to take on big organisations, ' she adds.

She also wants to see more being done about long-term care, a sensitive political issue that will become more important as life expectancies increase.

Another of concern is that the government has been seduced away from the less glamorous public health issues by the political benefits of cutting waiting lists.

'There is an over-influence of the glitz of cure and we do not have political agreement about the balance between societal and individual responsibility, ' she comments.

New Health Network chief executive Margaret Mythen

'Structural reorganisation is easier than cultural change, but it achieves far less'

Cultural change, according to Margaret Mythen, is the most significant achievement of the past few years.

'The most tangible improvement is the attitude to patients, recognising what is important to them, such as waiting times.

There is a recognition at every level that we must meet their expectations.'

She cites the expert patient programme, where patients with long-term conditions are used to give advice and help structure the service, as an example of this new culture.

However, she feels that too much emphasis has been put on creating 'shiny new hospitals' and not enough on dealing with chronic conditions in the community.

She also feels too little work has been on prevention. She accuses the public of being 'complacent' on public health. 'They do not eat healthily or exercise enough, ' she says.

When it comes to the future, she feels the government should congratulate NHS staff for their hard work, rather than constantly finding fault.

And, like many others in the health service, she doesn't want any more structural reorganisation. 'I think enough is enough.

Structural reorganisation is easier than cultural change, but it achieves far less.'

King's Fund chief executive Niall Dickson

'We should look at solving the needs of [service users] in employment and housing'

For Niall Dickson, the last seven years have seen genuine improvements - increased staffing levels, the reduction in waiting times and the reduction in deaths from cancer and heart disease.

'It is significant, ' he says, 'that prescription rates for statins have been pushed up, even in deprived areas, which previously failed to benefit from medical advances.'

There are still problems, most notably in mental health, where the proportion of NHS spending has fallen and where the number of people falling ill has risen.

'We need more staff such as community psychiatric nurses, ' he says, 'but we should also be looking at solving the needs of [service users] in employment, housing and social networks.'

He says that mental health services, particularly for young people, seem to be 'slipping off the agenda'.

There are several other concerns. 'We haven't solved the divide between primary and secondary care and we have to tackle the issue of public and patient involvement - the arrangements for involving the public in foundation hospitals haven't been properly thought out yet.'

Royal College of Nursing general secretary Beverly Malone

'Allowing nurses to take a leadership role has enabled them to improve patient care'

Not surprisingly, the RCN general secretary points to the greater responsibility being given to nurses as one of the major achievements of the last few years.

'Allowing nurses to take a leadership role has enabled them to make direct improvements to patient care.'

However, she wants to see more done, particularly in public health, where extra school nurses should be employed to advise and help children. She also wants more community nurses involved in tackling chronic conditions.

Over the next few years she would like to see more done to recruit and retain UK nurses, rather than trusts depending on international recruitment. And she would like to see the entire British National Formulary opened up to 'appropriately trained nurses'.

She wants nursing to be made more prominent. 'The government should deliver Agenda for Change. This will reward nurses more fairly.'

She also wants the NHS to retain its core values and remain free at the point of use and funded through taxation, but she believes that effective modernisation can only be achieved through working with nurses.

BMA chair Dr James Johnson

'Often the first we hear about an initiative is when it is announced on the news'

While welcoming the fact that waiting lists are falling and there are new chronic-disease management initiatives in primary care, Dr Johnson is concerned the NHS may be becoming too fragmented.

'I am generally in favour of using private providers in the NHS, but if you have a South African company doing cataract operations, we have to be sure that the arrangements are in place for pre-operative and post-operative care, ' he says.

He is also concerned that delayed discharge is still being dealt with by a mixture of private nursing homes, over-stretched social services and hospitals. 'It could become like the privatisation of the railways where no-one knows what is going on, ' he says.

For Dr Johnson, the biggest problem area is public health. 'It has been neglected for too long and this must be reversed.' He wants a ban on smoking in workplaces and claims this would be 'the single action which would have the most immediate effect on the nation's health'.

Dr Johnson would also like responsibility for public health to be taken away from the Department of Health and given a 'cross-departmental perspective' and 'increased political profile'.

'It is not just a DoH issue. We are talking about buying more school playing fields and influencing what goes on television.'

Like many chief executives, he urges the government to pay attention to health professionals. 'We do not feel We are being listened to. Often the first we hear about an initiative is on the news.

We have a lot to bring to the table and should allowed to contribute before policies are set in aspic.'

And the rest: what other lobbying organisations want

Out of all the chief executives surveyed, the last few years appear to have been a time of solid improvement.Most want to celebrate reduced waiting times and the effectiveness of cancer services.Other initiatives, such as the coronary heart disease national service framework, have won praise from organisations including the British Heart Foundation, whose director general Peter Hollins suggests that cardiovascular deaths will fall by 40 per cent by 2007 - three years ahead of the government's target.

But most chief executives think the government hasn't done enough to curb obesity and most agree that smoking should be banned in public places.

British Dental Association chief executive Ian Wylie suggests that public health should be run by an independent body, quite distinct from the NHS.

Diabetes UK chief executive Douglas Smallwood thinks many of the government's achievements exist only in the 'dreams of ministers'.

'These broad changes have yet to deliver top-quality care, 'he says.

Chartered Society of Physiotherapy chief executive Phil Gray wants patients to be able to refer themselves directly to physiotherapy and other services 'to enable real choice and speed up delivery'.

And Asthma UK chief executive Donna Covey thinks there is a 'lack of a holistic strategy', which means that people with chronic conditions are poorly served.'We need to think long term rather than capturing headlines in the Daily Mail .'

Asthma UK wants money spent to research why Britain has some of the highest rates of asthma in the world.Diabetes UK wants investment in diabetes services, Multiple Sclerosis Society chief executive Mike O'Donovan wants more trained staff and the British Heart Foundation wants more money spent on rehabilitation.