Policy ini tiatives stir NHS cash hopes

But despite well-briefed speculation in the weekend press suggesting the health service is to get an pounds 8bn-plus bonus from the comprehensive spending review, there is still doubt that a firm figure will be announced this week.

Among the announcements to emerge from the Department of Health, health minister Alan Milburn finally set out details of the proposed National Institute for Clinical Excellence and Commission for Health Improvement (see box).

Launching the document, A First Class Service: quality in the new NHS, he said NICE would give 'clear, authoritative, national advice' on the clinical and cost-effectiveness of new medicines, medical devices and procedures.

And filling out the government's quality agenda further, health secretary Frank Dobson appointed two senior clinicians to head the development of the first national service frameworks.

Professor George Alberti, president of the Royal College of Physicians, is to lead an expert group on coronary heart disease to develop national standards of care and performance measures.

Professor Graham Thornicroft, of the Institute of Psychiatry and Maudsley Hospital, will lead a similar group setting standards for mental health services.

Mr Milburn also invited applications for the second wave of Primary Care Act pilots, to go live on 1 October 1999. He said the government was making clear it wanted bids from community trusts and nurses as well as GPs.

Speaking in the Commons on Tuesday, Mr Dobson said early indicators from the NHS Executive showed that waiting lists had stared to fall. 'The supertanker has turned,' he said.

Public health minister Tessa Jowell joined in the good news offensive with an interview in which she said her Our Healthier Nation white paper, due in the autumn, would give health authorities greater power to introduce water fluoridation.

With 3,000 delegates arriving in London this week for a joint Institute of Health Services Management and NHS Confederation conference, organisers were hoping that star speaker prime minister Tony Blair would produce a cash boost for the NHS.

Confederation chief executive Stephen Thornton said: 'If he doesn't, he will still get a polite response because we are a polite audience. But if he does, and it is at least pounds 10bn, he could well get a standing ovation.'

But he conceded that there was pressure on Mr Blair not to offer a figure for the NHS in advance of the full comprehensive spending review announcement, due to be made later this month by chancellor Gordon Brown.

Liberal Democrat health spokesman Simon Hughes turned up the financial pressure, arguing that a pounds 2bn-a-year increase would be less on average, in real terms, than under the Major government.

He said: 'Only a one-off 5 per cent real-terms increase this year followed by a 4 per cent real-terms increase for the next three years will restore the NHS to a service able to do its job rather than sometimes struggling to do the basics.'

Mr Thornton said an extra pounds 8bn would meet the confederation's demands. 'In that sense, it is excellent news, but it is not a big bonanza by any means,' he said. 'We need that sort of money for the next three years - and every year.'

Health economist John Appleby said a figure of pounds 8bn-pounds 10bn spread over the three years up to the general election would be 'just about in line' with the 3 per cent real-terms growth sought by medical and management lobby groups.

'It takes the NHS back to its long-run trend of matching the growth in the economy,' he said.

'It is hardly unaffordable.'

See Comment, page 21.