Echoes of the corporatist 1960s and 1970s are coming thick and fast. First the NHS plan; now the instruction from health secretary Alan Milburn to 'go for growth'. Why does the language of NHS reform so evoke the era of Harold Wilson and Ted Heath?
Mr Milburn's order refers specifically to expanding bed numbers. The plan prescribed an extra 2,100 general and acute beds in England, building on recommendations from the national beds inquiry published in February. Oddly, the 'model for calculating the necessary number of hospital and other NHS beds needed in each area per head of population' will not be issued until next month; presumably, whatever the arithmetic locally, the nationwide total will not exceed 2,100 - a clever equation indeed.
Going for growth in bed numbers reverses a trend which began in the late 1950s, although the precipitous drop happened between 1979 and 1995, when numbers fell by more than 40 per cent. Though better primary care, more day care, more effective treatments and shorter stays played a role, so too did unashamed cost-cutting. As Mr Milburn rightly identified, reversing the trend will mean replacing a 'prevailing NHS culture' in which a continuous decline in bed numbers felt as inevitable as the sun setting at the end of every day.
But a reminder of how slowly cultural change comes about occurred on the day Mr Milburn issued his instruction. The Department of Health revealed that bed numbers continued to fall - by 511 - between 1998-99 and 1999-2000. Overall, overnight acute beds and day-case beds fell by 0.1 per cent, while the average daily number of available overnight beds across all specialties fell by 2 per cent. Critical care beds fell by 19 between January and July.
Mr Milburn's spin on this was to emphasise that bed cuts have 'slowed almost to a halt' compared to average annual losses in the last 10 years of 2,075, and already increased in three regions. But clearly the Dobsonian supertanker will turn only at an excruciatingly stately pace. In July ministers were forced to disclose in answer to a parliamentary question that the first wave of private finance initiative projects would represent a loss of 571 beds across 18 trusts. Thanks to the chancellor's largesse, lack of money ought no longer to be an obstacle to increasing beds, but a shortage of appropriately trained professionals to staff them is likely to be the decisive brake on progress.
The government is right to reverse a trend which had gone too far. But increasing beds is only part of the picture: changes here need to be co-ordinated with a wide range of developments in every locality. That guidance next month will be crucial.
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