Feature

Yes, Minister?

You may be unhappy about the state of the NHS, but what would you do as health minister? healthmatters readers and writers take up the challenge

’I would begin by trying to promote work between government departments especially the departments of the environment and trade and industry, the treasury and the Ministry of Agriculture, Fisheries and Food. I would certainly want to redress inequalities in health - both geographical and social - and I would look towards voluntary as well as statutory sector initiatives to improve health. But the voluntary sector would have to be properly resourced - I would certainly be committing more funds to it.’

Mercy Jeyasingham, National Development Officer, Black Health Unit, National Community Health Resource.

’My priority would not be just to make a simple knee-jerk reaction to the current round of Tory destabilisations, as Labour did in 1974. Rather, I would immediately initiate a more fundamental programme of change based on two important principles: the introduction of genuine democracy into the delivery of health and health care; and the integrated planning of social, economic and environmental policies for health. Both these cover what we now think of as the health services, but would be aimed at setting health care in a wider context of improvement in health and a reduction in inequalities in health status.

For me, these twin principles can only be achieved by bringing health planning together with other fields of social, economic and environmental planning under a reformed system of local government.’

Colin Thunhurst, Nuffield Institute for Health Services Studies.

’We would create a new national independent body to inspect health, social services, private and voluntary settings where people with a mental handicap live and work. It would have a statutory right to implement change.

There should also be a new national structure for community nursing services which would acknowledge community nurses for their clinical expertise and clearly define their role. We would ensure commitment to caring came before financial concerns. Management accountability would be not only to the health authority but also to health service workers and users.’

Jude Francis, Paula Stanliland, Peter Yee, Carol Dowling and Andy Law, community mental health nurses.

’My first task would be to convince cabinet colleagues to instigate an anti-poverty programme to narrow the gap between rich and poor, and to renationalise public transport with a view to reintroducing a cheap fares policy.

I would argue for a vigorous programme of council house building and for immediate measures to house all homeless people. I would also repeal all laws which make homosexuality a criminal offence. And of course ban tobacco advertising and sponsorship.’

Lee Adams, Director of Health Promotion, Sheffield Health Authority.

’Naturally I would wish to strengthen the NHS and stop the present slide towards a two-tier system and privatisation. But health is about much more than the NHS.

A cabinet committee on health would need to be set up with ministers from all the major departments - health, education, the environment, trade and industry, the Home Office, the Treasury, agriculture, and social security. It might best be chaired by the secretary of state for the environment.

The first things to tackle would be bad housing, unemployment, poverty and smoking. At the very least pensions and child benefit should increase in real terms, and benefits be returned to 16 and 17 year olds.

I would also push for a complete ban on tobacco advertising except at the point of sale.’

Dr David Player, previously director of the Health Education Council.

’Well, for a start we’d bring all the trusts properly back into the NHS and most definitely get rid of GP funholding. In fact, we’d like to see like many GPs themselves - a salaried GP service.

We would give community health councils (CHCs) greater powers and finance to enable them to carry out their role in the NHS. We would take CHCs away from regional health authority control and create an independent establishing body for CHCs at national level. This body could also be concerned with setting and monitoring standards throughout the NHS and local authority departments concerned with community care.

We would like to see a fully democratic publicly run and financed health service with both commissioning and providing arms at local level. In London we would create a single regional health authority to cover the capital.’

Ros Levenson and Nikki Joule, Greater London Association of CHCs.

’If I were minister for health I would abolish smoking and restore the free eye test. I would allocate increased resources to reduce waiting lists and promote an increased emphasis on primary health care and prevention. This should include annual check ups for all those over 75 which would automatically benefit disabled people, the majority of whom are elderly.

I would like to increase environmental awareness since the attrition of the ozone layer is likely to increase the incidence of skin cancers and cataracts.’

Colin Low, director of the London Boroughs Disability Resource Team and vice-chair of the Royal National Institute for the Blind.

’As next health minister, I would bring GP fundholders and trust hospitals back under FHSA/DHA control, and make the health authorities locally democratically accountable to health workers and the community. NHS funding would have to be greatly increased, financed by reducing “defence” expenditure.

I would initiate wide consultation with health workers and users about the changes they would like to see - and fund pilot studies to try them out. And I would offer a salaried service to GPs - initially as an option alongside independent contractor status.’

Dr Janet Power, general practitioner and member of the General Medical Services Committee.

’My experience - like that of countless other nurses who have contacted me - is that hospital care of the elderly in this country is, in places, a downright disgrace. I would set up a high level enquiry urgently - perhaps a Royal Commission would be needed.

A way must be found, by legislation if need be, to enable NHS staff -

especially nurses and doctors - to speak out about perceived danger to or neglect of patients, without fear of intimidation or punishment.’

Graham Pink, night charge nurse sacked by his employer for speaking out about standards of care.

’Were I health minister I would start by asking a committee of the House of Commons to investigate the procedures used by health authorities, the GMC and the UKCC to see if they meet the needs of pregnant women. Then I would establish an Office of Technology Assessment to look into the safety, efficacy, wider social implications and costs of medical technology.

I would require an immediate randomised controlled trial of ultrasound to be undertaken, ensure that midwifery beds are available in all maternity units, and require GPs wishing to remain on the obstetric list to undergo a compulsory refresher course every five years.

And I would establish a separate NHS fund to deal with compensation and legal settlement.’

Beverly Lawrence-Beech, Association for Improvements in the Maternity Services.

’On day one I would scrap performance related pay, dump the billing system and liberate all press, public relations and corporate development personnel. All those employed to define and achieve this curious concept of Quality would similarly be released.

To spend the vast amount of money thus released I would train and employ as many nurses as nursing representatives feel would be necessary to care for people decently again, both in the community and the acute sector. I would also increase the number of cleaners and porters in the acute sector, without whom better standards will never be achieved.

I would borrow the Labour Party’s idea of service sampling and ensure that senior managers spent a minimum of one day per month working in each department in turn.

By day two, of course, I would have succeeded in persuading the Treasury to fund the NHS to European levels.’

Julia Schofield, director, NHS Support Federation.

’In the current environment I can see no way of ensuring standards. The competition is not competition for excellence, it is competition for financial viability. No contract is going to state the details of nurse staffing levels, or the maximum number of hours a junior doctor will have been up before the patient is seen, or the degree to which the toilets are cleaned.

Market forces should be removed from the NHS before any further destruction takes place. I would establish district standards committees, made up of health care professionals from hospital and community together with representatives from the community health council, to which management at district level would be accountable.

Change should be effected as a process of evolution, in a spirit of humility, and in the knowledge that no unit of care is a standard one and no patient is a textbook case.’

Dr Helen Zeitlin, consultant haematologist made redundant after speaking publicly about nursing shortages.