The Health of Our Hospitals .sx By Virginia Bottomley MP .sx Minister of Health .sx The title raises an interesting question .sx How do you measure the health of a hospital ?sx By numbers of patients treated ?sx By numbers of staff ?sx By its balance sheet ?sx The NHS reforms give us a radical new definition .sx In future , the health of hospitals will be tied directly to their contribution to better health for all .sx Remarkably , this has never before been the case .sx This transformation stems from the division of responsibilities in the NHS between the providers of services - including hospitals - and those who plan and purchase health care - health authorities and , for a range of non-urgent treatment , GP fundholders .sx Hospitals are now paid for the services they provide through contracts made by health authorities and GP fundholders on behalf of local people .sx 'Money following the patient' has rightly become a familiar phrase in the healthcare lexicon .sx Its impact is fundamental .sx For the first time , hospitals have an incentive to adapt the services they offer to what health authorities and GP fundholders want to secure .sx In the past , the hospital 'cash-limit' provided no such incentive .sx Priorities for funding were often determined by the pecking-order among different clinical specialities , with little reference to what services were actually needed locally .sx Lord McColl , the Director of Surgery at the Guy's and Lewisham NHS Trust , described what the new system means for his hospital , as it does for all others :sx " The Guy's and Lewisham Trust is .sx .. reviewing every service and asking fundamental questions such as :sx 'Is this service of high quality ?sx Is it relevant to the needs of our local population ?sx How cost-effective is it ?sx Are there some people who could do the job a bit better ?sx ' .sx .. We shall be driven by the vision of producing for our local community the most relevant hospital and community services to match needs and expectations for the next 10 to 20 years and at a cost that is affordable by the taxpayer .sx " .sx At last , hospitals are focusing on patients' needs first and foremost .sx Inevitably , this brings more challenges than under the old provider-dominated system .sx Far easier to go around with eyes and ears closed .sx For easier to continue providing the same old services .sx Hospitals now face the challenge of ensuring that resources are targeted as efficiently and effectively as possible .sx They are now having to address issues some have avoided in the past .sx Has overmanning prevented resources from being channelled towards essential maintenance work ?sx Have staff been deployed in the most effective way ?sx The result , already , is a range of innovative approaches to providing patient care .sx The Kingston Hospital NHS Trust is planning to build a 'patient hotel' , where NHS patients who do not require medical care , but who are not well enough to go home , can be looked after .sx Patients will benefit from a comfortable and relaxing environment ; the hospital will be able to make better use of existing beds for those in need of more intensive care .sx In a number of hospitals , local managers and clinicians have decided that fewer , more highly qualified and better paid staff are an essential element in an overall package of improved service provision .sx But others , particularly in areas of growing population , are planning to recruit more skilled clinicians to improve quality of service .sx It is naive to believe that service provision will remain static now that users of services have a greater say .sx What is important is that patient care should be the guiding criterion behind change .sx Even more striking - and surely more relevant - is the evidence of a drive to improve quality of care and responsiveness to patients .sx Through NHS contracts , hospitals are committing themselves to consistently high standards of care .sx For example , some have undertaken to give a minimum of seven days' notice of in-patient admissions in order to give people time to prepare for treatment .sx At the East Somerset Trust , a consumer council is being set up to allow patients to have their say about the service they receive .sx The Bradford Hospitals NHS Trust has an Equity Committee , to ensure that the local community's views are heard in decisions over services .sx Of course , such initiatives build on existing best practice in the NHS .sx What is new is that sensitivity to patients' needs is now a prerequisite of success .sx The common factor linking these initiatives is a determination to make the most of opportunities presented by the new NHS .sx Devolution of responsibility for running hospitals under our reforms has given local managers and staff the means to act .sx Managers are facing up to challenges which have been thrust under the carpet for too long .sx Encouragingly , they are involving hospital staff in decision-making .sx It is increasingly clinicians who are taking the key decisions on how to run hospital departments .sx Many ward sisters now have substantial ward budgets which they deploy to get the best standards of service .sx The new freedoms go furthest in NHS Trusts and it is there that we are seeing some of the greatest progress .sx But all hospitals are now enjoying more local control of resources and decision-making .sx I see NHS Trust status as the model of choice for our hospitals .sx Stronger links with local communities , involvement of staff , the power to take decisions locally are the way forward .sx It is encouraging that over 100 hospitals and other units have now published applications to join the 57 existing NHS Trusts .sx It is a vote of confidence in our hospitals and in the opportunities offered them by the reforms .sx The Opposition's criticisms of our reforms are revealing .sx Some are misguided , some plain mischievous .sx Claims of NHS Trusts leaving the NHS have been repudiated , forecasts of massive redundancies have turned out to be greatly exaggerated .sx Sadly , the Opposition's obsession with the status and manning of hospitals reveals an inability to move away from a view of the NHS that measures its effectiveness by the number of hospitals and numbers of staff .sx That might have been relevant in 1948 .sx The reforms make sure that the NHS focuses its attention more firmly on improving people's health , and links the health of hospitals to this .sx Satisfying people's needs will always be demanding .sx But it is surely the best measure of a successful and healthy hospital .sx No To A Two Tier System .sx By Harriet Harman MP .sx Shadow Minister of Health .sx The Government should listen to the mounting public concern about the NHS and the lack of confidence in the Government's health policies .sx So far , the Government has said it is determined to press on with its reforms in the teeth of opposition from doctors , nurses and other health workers and opposition clearly expressed in successive public opinion polls .sx The Government say that people will learn to accept the NHS changes and get used to them .sx But that is what they said about the poll tax .sx The Government must recognise that it's not that the public don't understand what the reforms are about .sx The public do understand the reforms and they don't want them .sx Under the internal market , hospitals no longer get their income directly from the Government ( via the district health authority) .sx Instead they have to earn it by winning contracts to treat patients .sx The contracts are placed by district health authorities on behalf of people who live in their district , or by fund-holding GPs who place contracts for the care of the patients on their list .sx This is already causing problems for patients , through lack of choice and freedom to refer , and inequalities in a two tier system .sx For example , women will no longer have the choice of which hospital to have their baby in .sx This decision will now be taken by the district health authority manager who will place a contract for maternity services .sx Health Authorities are required to keep a contingency fund to pay for the treatment of residents who choose to go to a hospital different from the one chosen by the health authority managers .sx However , the amounts set aside are tiny and patient choice is set to become another casualty case in the new NHS .sx The internal market is leading to a two tier system where patients with non - budget holding GPs take second place to patients with budget holding GPs .sx In Welwyn Garden City , the Queen Elizabeth II hospital is offering fast track admission for cataract operations to patients of GP budget holders .sx Meanwhile a local resident whose GP is not a budget holder has been told she will have to wait two years - until she is 75 years old - before she can get the operation .sx Competition in the internal market will be on cost rather than quality .sx Opt out hospitals are to be the leading edge of the internal market .sx They are to be the market leaders - in salesmen's jargon .sx Where opinion has been tested the majority of people are overwhelmingly against opt outs .sx The Government pressed on however and made 56 hospitals into trusts .sx We have already seen the effects of this in hospitals like Guy's which announced nearly 400 job losses and is talking about inevitable reductions in direct patient care services .sx Over 100 hospitals have now been targeted for opt out in the second wave .sx At the very least the Government should put on hold the second wave of opt outs until they have sorted out the problems of the first wave .sx Trusts are fragmenting the National Health Service .sx They are not accountable to the local community - the first directors appointed to the opted out hospitals are nearly all businessmen .sx The primary focus of trusts will be to focus on the financial survival of the institution rather than the services needed by local people .sx That is why Labour will bring back opted out hospitals into the local health service .sx We want our hospitals to work together for patient care not competing for trade .sx The Government's review of the NHS was born out of national concern about the underfunding of the service .sx These problems have not gone away .sx The recent Health Select committee report on waiting lists said that the human misery and financial cost of long waiting lists are impossible to quantify .sx The National Audit Office has reported on the appalling backlog of maintenance in the Health Service .sx Hundreds of thousands of operations are cancelled each year .sx Community health services are overstretched as people are discharged more rapidly after operations .sx The present financial crisis in the Health Service developed over many years and will take time to put right .sx To redress fully the neglect of the past decade may well take at least the lifetime of a parliament .sx Labour is determined to tackle this legacy of neglect .sx The increasing number of very elderly people calls for extra resources , as does the development of medical technology and knowledge .sx Labour will invest in the modernisation of our hospitals and tackle the backlog in maintenance and repairs although we cannot expect to be able to put right overnight the neglect of years .sx Labour will not cheat health authorities by agreeing pay awards and then fail to fund them .sx What is needed is not the internal market to squeeze cost out - but sensible investment matched by commitment to improve services .sx Regions should allocate funds to districts on the basis of Performance Agreements negotiated between regional and district authorities .sx These performance agreements will reflect our strategy to shift greater priority into health promotion and community based service and will provide a statement of targets , priorities and quality for the acute sector .sx We will empower patients with new rights and have published a Charter of Patients' Rights .sx We will establish a Quality Commission .sx Labour's 'Better Way to a Healthy Britain' sets out 30 practical steps in an action plan for better health .sx In contrast , the Government's recent Green Paper , The Health of the Nation , contains no new proposals for Government action and includes targets which are nothing more than pessimistic predictions of current trends .sx On community care we will enable each individual to achieve as full a participation as possible within the community .sx Spending on community care should be clearly identified and ringfenced .sx