The Liberal Democrats took a leaf out of education policy with calls for a health National Curriculum. Patrick Butler listened to heated debates on rationing

The Liberal Democrats last week become the first of the big three political parties to pledge themselves to a full debate over NHS rationing, backing calls for a standing conference to draw up a 'National Curriculum' of core services.

But the party's Brighton conference hedged against coming up with a lengthy, potentially unpopular list of exclusions by voting to 'significantly increase the share of GDP spent on health, currently grossly inadequate, to ensure that those who rely on the NHS can get the health they need'.

Delegates also backed a proposal that would give health and social services committees the power to raise cash through the council tax to pay for the local provision of 'non-core' NHS services not included in the curriculum.

Health spokesman Simon Hughes told the conference that the party was prepared to confront the 'politically unacceptable topic of rationing head on' with an NHS contract that would set out what people get for their money.

'We are being honest with people. Patients should know in advance what they will get.'

He added: 'We propose that professionals, patients and politicians together draw up the menu of what health services we get for our tax pound, rather than letting NHS clinicians and managers decide for us.

'We suggest nothing less than a National Curriculum for NHS services.'

Later he expounded on this at an Institute of Public Policy Research fringe meeting, saying that however unattractive rationing was, there was always a limit to what services the NHS could provide, and it was important to get this into the open.

'In 50 years of the NHS there's never been a debate where we have said to the public 'If you give us 50bn you will get this, if you give us 40bn you will have to knock off the list this, this and this'.

'We are saying let's have a debate and let's have it in public.'

Mr Hughes - seen by some as a future contender the leadership for the party - made it clear to conference that he was in favour of raising more cash for the NHS 'through fairly graduated taxation' to minimise rationing.

'Insufficient funding of public services is right-wing politics and we must have none of it.'

Peter Brand, the party's public health spokesman and a GP, said there should be a 'serious debate' about whether to have a 'grey area' of non- core services, which while they could be accessed through the NHS, would require 'tapered contributions' from patients - 'a nice way of saying means testing', he admitted.

But the idea of rationing jarred with most Liberal Democrats. One delegate said: 'The NHS is 50 this year - time to re-examine policies, not to have a midlife crisis, not to press the self-destruct button.

'At the end of the 20th century I do not regard it as radical or forward- looking to go back to the 19th century.'

Evan Harris, a health spokesperson, touched on the dangers of rationing in his critique of the government's decision to ban Viagra - and potentially other drugs - from the NHS.

'One man's moderate obesity is another's morbid obesity. One man's moderate limpness is another's nervous anxiety and marital breakdown.'

Jean Fooks, an Oxford city councillor, reflected the views of many of the rank and file when she called for more investment to bridge the gap between demand and resources.

'If we want champagne treatment we must make sure the NHS gets more than brown-ale income.'

James Walsh, a GP and leader of West Sussex county council, attacked the creation of primary care groups as 'the final act of Stalinist collectivisation'.

It was 'undemocratic', 'unrepresentative' and would 'end in tears', as the public laid the blame for rationing with GPs.

Liz Lynne, former MP for Rochdale and health spokeswoman, now on the party's list of Euro MP candidates, blamed the government for failing to address nurse shortages.

'If we do not take drastic action, mark my words: we ain't seen nothing yet.'

Stephen Gallagher, health service development director at Argyll and Bute trust, and a party vice-president, said the Liberal Democrats would use the Scottish parliament to customise the NHS north of the border to Scotland-specific needs.

Ideas being floated by the Scottish Lib Dems included the introduction of universal preventive health checks, restoring responsibility for public health to local authorities, expanding the role of the health visitor, and reducing the number of health boards from 15 to between five and ten.

He said the emphasis in the NHS north of the border had to be on illness prevention, public health, and closing the gap in life expectancy between rich and poor.

'Let Labour claim it's the party of the health service; we the Liberal Democrats are the party of health.'

What the party wants: policy demands

operational independence for chief medical officers;

an NHS contract between users and providers;

merger of health and social services;

maximum six-month treatment waiting times;

a freeze on prescription charges.