Headlines: June 27th, 1997

Health Secretary Frank Dobson unveiled his strategy for health at the annual conference of the NHS Confederation. A key feature of the strategy is moving from competition to co-operation. Mr Dobson said, “We have got to get every part of the NHS working together. We simply can’t afford some of the wasteful crack-pot competition that the internal market provoked at the outset. I know as a result of the bitter experience of competition, the idea of co-operation is making a comeback.”The strategy will be supported by Government action across the board. He said: “We have got to have an NHS fit for the 21st century. That’s because we want the people of this country to be fit enough and well enough to meet the challenges of the coming century. And that can’t be achieved by the NHS alone. We have got to use the whole machinery of Government to tackle the things that make people ill. And we are taking action – action against tobacco, action against alcopops, action to improve food safety. Air pollution chokes us all and most of all it chokes older people and children. The Department of the Environment, Transport, and Regions is taking action to reduce traffic pollution. All these measures, and more, will improve the nation’s health.”

A practical way of taking forward the co-operation strategy may be through projects which would explore mechanisms for breaking through current organisational boundaries to tackle inequalities, and deliver better services and better health care. Mr Dobson outlined the possibility of designating a small number of areas as “Health Action Zones”. He said: “Within the Health Action Zones which I have in mind, all those involved in delivering the NHS on the ground would be brought together to develop a health strategy in co-operation with community groups, the voluntary sector, and local businesses. We envisage the Health Action Zones demonstrating the dynamism which is released when people and organisations are given the responsibility of working together to achieve agreed targets.” In contrast to the current standardised competition arrangements across the health service the Government is looking for models to emerge which are tailored to local circumstances.

The projects would bring together NHS bodies, local authorities, community voluntary groups and local businesses. No additional funds would be provided. Success would come from targeting effort and shifting the funds around. There is, however, a possibility that through local authorities, the zones could draw on the Department of the Environment’s £3.4 billion regeneration budget. The plan is to set up eight zones with a population of up to one million people.

It is thought that this radical approach to health care would result in the movement of services out of district general hospitals, many of which might be downgraded or even closed. The Government will produce a health white paper in the autumn and it is likely to include the action zones plan.

The Secretary of State’s announcement ties in closely with the setting up earlier in the month of the NHS Efficiency Task Force. The senior managers and clinicians who make up the task force will explore more effective ways of delivering high quality patient care. They will seek examples of both good and inefficient practice. The findings of the task force will be used to inform policy and contribute to the autumn white paper.