Private finance initiative will 'reduce anxiety about funding'

The investment required for the government's long-term agenda for the NHS will mean greater private sector participation, a panel of experts told a fringe meeting.

But there was scepticism about whether the government would engage the public in such a debate as it might prove unpopular with voters.

Independent Healthcare Association policy director Tim Evans said the effective but largely silent privatisation of long-term care was an example of the way forward.

Andrew Foster, controller of the Audit Commission, said: 'There has always been a great deal of caution about the notion of the threat to NHS services.' He said the private finance initiative would be used, just as the privatisation of long-term care had been, to 'reduce anxiety about privatisation'.

Contrasting sub-cultures divide hospital staff

Attitudes and beliefs can limit the drive to achieve higher quality and more cost-effective services in hospitals, a fringe meeting on tackling sub-cultures heard.

Presenting the findings of a study, Michael Hills, visiting professor at London University, said doctors and medical managers regarded power inequalities as natural, necessary and beneficial. They attached little value to having a supportive superior, and backed a medical ascendancy model of management.

But nurse clinicians and managers rejected the view that inequalities of power were natural, necessary and beneficial. They supported a team-based approach in the management of clinical units. The findings were based on a study of hospital staff - including lay managers - in two Australian teaching hospitals and four English hospitals.

Consumers' Association head continues right-to-know fight

Consumers' Association director Sheila McKechnie told the conference of the difficulties she had experienced in trying to see her own medical notes.

'I asked a very young doctor... if I could see my notes. He said: 'You're not allowed to see your records'. I told him: 'You are looking at one of the founders of the Freedom of Information Campaign which was responsible for getting records opened up to patients. Now go and get my notes'. He did.'

Ms McKechnie said although she may have been 'the patient from hell', patients' needs must be met by a modern NHS.

HAZ bid could help plight of child drug dealers

The collapse of social structures in Lambeth, south London, had led to children of eight years old being involved in illegal drug distribution, said Lambeth council chief executive Heather Rabbatts.The borough's health action zone bid aimed to help them. 'Those children are known to all of us - social workers, the health authority, police and probation service. Yet those professionals very rarely sit in one room together and think about how they might make a difference to their future.'

It would mean working outside organisational boundaries 'that we have all come to know and love', and accepting accountability for services one did not manage directly, she said.

Neuberger urges Labour to rebuild NHS vision

The NHS was pretty safe in Labour hands but prime minister Tony Blair and his team needed to do more to create a new vision of the health service as it entered the 21st century, said King's Fund chief executive Julia Neuberger.

In a well-received speech, she rejected suggestions that the NHS was reluctant to modernise and blamed politicians for blocking change. Appealing for political leadership to help the service engage in the wider debate with the public, Rabbi Neuberger asked: 'Will our prime minister lead us in our attempt to create new public sector values for the next century?'

We can't afford old-age care, says finance chief

The public needs to be involved in debate about the level and quality of care it is prepared to pay for because the NHS cannot cope with the demands of an ageing population, Financial Services Authority chair Howard Davies warned.

He said the number of economically inactive men in their 50s had risen from 4 per cent to 21 per cent of the population from 1975 to 1995.That had meant an increased incidence of heart disease and cancer, bringing greater demands on the NHS. He predicted most nursing and residential home care would have to be funded privately in the next century. Mr Davies chairs the presidents committee of the NHS and BUPA-backed Millennium Debate which will survey public thinking on healthcare.