TY - JOUR T1 - Keeping the NHS on course: politicans' proposals for the next 4 years JF - British Journal of General Practice JO - Br J Gen Pract SP - 378 LP - 380 DO - 10.3399/bjgp10X501976 VL - 60 IS - 574 AU - Roger Jones Y1 - 2010/05/01 UR - http://bjgp.org/content/60/574/378.abstract N2 - Climatic metaphors describing the state of our economy as chilly, arctic, and frozen are becoming overworked, but it's almost impossible not to think of sea-going terminology to describe what needs to be done to the NHS — steadying the ship, battening down the hatches, rearranging the deckchairs — and a number of these cropped up in my recent interviews with the three political parties' health spokesmen and a reading of their policy documents.Norman Lamb, the Liberal Democrat Shadow Health Secretary, describes, in the introduction to the LibDem document on the NHS ‘A Liberal Blueprint’,1 the current funding problems of the NHS as ‘the conditions for a perfect storm’, with potentially disastrous consequences. His party's approach to ensuring the survival of the NHS includes an emphasis on decentralisation, on reform of NHS funding, on the development and enfranchisement of the workforce and on supporting patients in taking responsibility for their own health.According to Lamb, centralised management of the NHS has ‘been tested to destruction’, and local accountability is the answer. PCTs will give way to local health boards able to raise revenues and determine patterns of expenditure. Strategic health authorities will be abolished, along with large numbers of quangos, inspectorates, and one-third of posts in the Department of Health. The amount spent by the Department of Health on advertising and public relations will be slashed. Payment by Results will be significantly altered, with changes in the tariff and a strong emphasis on the development of Integrated Care Organisations, with primary care, secondary care, community services and, in some instances, social care organisations working together with unified budgets and aspirations, captured in a LibDem neologism ‘Competitive Localism’. Returning autonomy to NHS staff is seen as a priority, and the Blueprint document is peppered with examples of engaging, … ER -