Published: 17/03/2005, Volume II5, No. 5947 Page 21

Chris Ham on the policy gaps in Labour's mini manifesto

The marks of Blair and Brown are clearly visible in last week's Labour mini manifesto on health policy.

The chancellor's influence can be detected in the emphasis placed on what Labour has achieved so far. The manifesto lists improvements in health and healthcare that have been made since 1997 in a recitation of statistics of which former health secretary Virginia Bottomley would have been proud.

The prime minister's influence is evident in the ambition of going beyond what has been achieved so far by extending choice and increasing plurality of provision. Echoing the commitments already set out in last year's NHS improvement plan, Labour's document is uncompromising in its aim of extending market principles and completing the job that has been started in the second term.

Only occasionally does the mini manifesto reveal new snippets of information about the NHS of the future.

These include an estimate that around 7 per cent of elective operations will be delivered by the independent sector by 2008, and that waits for MRI scans will then average three weeks to enable the 18-week 'start to finish' target to be achieved.

The picture painted is limited by its focus on elective services. There are only passing references to primary care and long-term conditions, and nothing new on public health and prevention.

Some of these gaps will be filled when the election campaign starts in earnest and Labour's full manifesto is published. But even then it is unlikely that the most serious omission from the mini manifesto will be filled: an account of what will happen when the current NHS funding commitment expires.

For those in the NHS, as well as for patients, 2008 is a critical watershed.

By then, waiting times will have fallen to the point when they are no longer the main issue of concern to the public, and the gaps in funding and capacity inherited by Labour in 1997 will have been bridged.

As the mini manifesto makes clear, in effect NHS funding will have trebled between 1997 and 2008. Managers will have become accustomed to planning for growth and it will not be easy to adjust to an environment in which resources are much tighter.

Yet that is what they will have to do, because by 2008 other claims on public spending will take priority. The really interesting questions for Labour are its plans for the medium and longer term.

Will enough progress have been made on public health to fully engage the public (as Sir Derek Wanless argued was necessary) in order to moderate the demand for healthcare?

Will the expansion of capacity and competition between providers have driven the improvements in efficiency needed to sustain short waiting times when spending reverts to trend?

Will practice-based commissioning have created strong enough incentives for primary care teams to substitute community alternatives to hospital provision?

Above all, will the systems reforms now being implemented have delivered a creative equilibrium between choice and plurality of elective care, and continuity and integration in the treatment of those with long-term conditions?

These may not be questions to grab the attention of headline writers, but they are the questions that HSJ readers will expect to see addressed. And if answers are not forthcoming from the authors of manifestos, those charged with transforming the NHS from the integrated system it once was to the 'organising idea', to quote Mr Blair, it is in the process of becoming, must fill the vacuum.

Chris Ham is professor of health policy and management at the Birmingham University and was until last year director of the strategy unit in the Department of Health.