Health experts attack Blair's NHS remarks

Health economists are urging the Labour party to come clean on its plans for a revamped NHS, after Tony Blair announced earlier this week that a Labour government would reverse the internal market in health introduced by the Conservative administration.

Carol Propper, professor of economics at Bristol University, said: "To scrap it altogether would be extremely costly and an inappropriate response to the problems of the health service.

"Until Mr Blair tells us exactly what he means, saying he will start again is a bit of an empty politician's phrase. If he means removing from GP fundholders and district health authorities the flexibility to choose where they place their contracts, that's a retrograde step.

"If, on the other hand, he would like to cement relationships between health care providers [trust hospitals] and fundholders by encouraging longer term contracts, that is not so ridiculous. But it would represent a trend that is taking place anyway."

Professor Propper urges the Labour party to "think carefully about the strengths and weaknesses of the health service" before reversing the changes of the past five years. "Transactions are costly at the moment, but these could be teething problems," she said.

David Hunter, director of the Nuffield Institute of Health at Leeds University, describes Labour's current plans for a more efficient and equitable NHS as "vague and involving a re-labelling exercise without much substance".

He said: "The present system is very bureaucratic and cumbersome without the gain we were hoping for and there is a lot to be said for going back to an integrated system, but with better management controls than before. But I don't get the impression Labour are interested in doing any real thinking into this - they are only interested in winning the elections."

Chris Ham, director of health policy management at the University of Birmingham Health Services Management Centre, is also concerned by Labour's seemingly insubstantial plans for the NHS.

"They say they will keep the purchaser/provider split, suggesting hospitals will remain self-governing, and that they will put more people on [trust and health authority] boards, but they have not done a lot of in-depth thinking into the practicalities of change."

Professor Ham anticipates only minor tinkering with the health service under Labour. "They will probably replace fundholding with GP commissioning [where a GP influences a health authority's spending] and more priority will be given to public health and disease prevention but there will be no bang," he said.