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Hewitt's new broom? GPs can cope with just about anything

NHS lessons from history

I am sure I join everyone in welcoming Patricia Hewitt to the Department of Health. Far be it from me to suggest the future direction of the NHS, but I think we should consider a few aspects from the past.

The postwar Attlee government came to power in 1945, with the country on its knees. Attlee had a majority of 200.

The architect of the NHS, Aneurin Bevan, said: 'We ought to take pride in the fact that despite our financial and economic anxieties we are still able to do the most civilised thing in the world ­ put the welfare of the sick in front of every other consideration.'

The NHS Act was introduced in 1948. Huge socialist feelings, after years of neglect, especially between the two world wars, prevailed and the NHS was born.

There is no doubt the NHS was an awesome achievement, held in the highest regard. It boasts a huge asset base in the dedicated staff that provides frontline care.

The political record is rather more chequered. There have been habitual tendencies to reorganise and micromanage. Resources have been an issue right from inception.

Moment of revelation

If we leap forward a generation, a similar moment of revelation came in 1997, reminiscent of postwar 1945. New Labour gained credit for confronting failures of the NHS and swept into power with a 179-seat lead. Labour has done much in its eight-year tenure, but revitalising spending on public services has only partially reversed years of underinvestment.

We have reached a nadir. The Blair majority is down to 66 (if you think this is bad, Clement Attlee clung on to power with a margin of six in 1950 and only lasted nine months).

Blair and Brown have committed themselves consistently to three things. They have stolen the centre ground, throwing off allegations of tax and spend, they have reversed Labour's aversion to the private sector and they have introduced more widespread market reforms, following plans laid down by the Conservatives in the late 1980s.

Tough times ahead

What direction will we see the third term take with Mrs Hewitt at the helm? Labour has staked its reputation on commitment to public services. They have honourably picked up the bill for past neglect and followed Wanless in taking health spending up to our European partners.

Some tough times lay ahead, the economic surplus is over, heath costs soar and demand reaches new peaks every year.

Output lags behind spending. Staff shortages and pensions threaten morale. Targets distort communication, health care priorities and frontline care.

Tough job, you bet. In my view the greatest honour in the Cabinet. Will this government avoid the fate of the Attlee administration?

I reckon stewardship of the NHS will hold the keys to number 10 in 2010.

Dr Andy Jones is a GP in Stamford, Lincolnshire

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