comment: They deserve more vocal support from managers - and consultants

Published: 07/10/2004, Volume II4, No. 5926 Page 19

It is a sign of health secretary John Reid's confidence in his success that he can highlight the controversial nature of independent treatment centres - indeed wear it as a badge of pride. He was not quite gleeful, but in his apparently unscripted contribution to a Labour Party conference fringe meeting last week there was a sense of satisfaction in a battle well fought and all but won (news pages 3-5).

In principle, we have always known that the introduction of treatment centres would drive down waiting lists and therefore drive down private sector prices and reduce consultant power. This was not affected by the Department of Health concession that NHS consultants could work in the centres - which is why the DoH was happy to grant it.

When the centres were announced last September, Mr Reid said approvingly that they would 'disturb the old comfortable pattern'.

But he has not chosen to be so candid before. The health secretary touched on it in a less public forum when the patient choice paper Building on the Best was launched at the end of last year. With the prime minister beside him, he led a discussion on the 'vested interests' that stifle progress. It is no coincidence that one of the incentives proposed by the paper was the greater use of the private sector in primary care.

To repeat the colourful phrase used by fellow minister John Hutton elsewhere at the Labour conference, the government refuses to be held over 'a monopoly barrel' by either domestic private companies or consultants. ITCs may be a shortterm fix, but as every capitalist knows that is exactly what is needed when you are trying to break a cartel.

Obviously there is a political context to his remarks - he must feel that Labour has not received the credit it deserves in hammering the complacent homegrown independent sector. The new approach is paying dividends - and NHS managers and consultants should be more vocal in supporting it.