Dobson pledges fairness on health

A drive to end inequalities in health and reintroduce fairness to a system that had lost sight of it will be at the centre of the Government's plan for improving the NHS, Frank Dobson, the Secretary of State for Health, said yesterday.

New hospitals, more clinical staff and a focus on the health problems of the disadvantaged were among eight pledges Mr Dobson made, adding: "If we succeed, we will be able to come up with the sound bite 'Vote Labour, live longer'."

However, giving his first public speech as secretary of state, Mr Dobson made it clear that delivering on Labour's pledge to dismantle the internal market would take years rather than months, to allow experiments with alternative arrangements to be tried and evaluated.

Ending "two-tierism" and the other aspects of the internal market would require a "two-stage rocket" with some immediate measures - common hospital waiting lists for patients of all GPs, both fund-holders and non-fund- holders, is one possibility - while others would take longer.

"I am sure most people in the NHS would want us to get on with it quickly, but I am also sure they would like us to get it right," Mr Dobson said.

Speaking to the Royal College of Nursing's annual conference in Harrogate, Mr Dobson announced an end to the unpopular system of local pay under which staff in each NHS trust negotiated a local addition to the national pay award.

The system, introduced three years ago and intended to make trusts sensitive to local market forces, was suspended last year because of criticism that it was unfair and unwieldy.

Local pay had failed, Mr Dobson said. To applause, he added: "It has proved unpopular and divisive. It has dissipated goodwill and negotiations have consumed effort vastly disproportionate to the minuscule sums involved."

Renewing his warning that there would be no large pay increases, he said work would begin immediately on devising a new national pay system "with appropriate local flexibility". But he refused to spell out what this might mean. The RCN said supplements such as London weighting and those already paid in certain shortage specialties could be extended.

In a speech that was long on symbolism but short on strategy - and rapturously received by his 1,500-strong audience - Mr Dobson declared war on the "gross inequalities in health" associated with poverty, unemployment and homelessness, a personal commitment he is known to share with Sir Kenneth Calman, the Government's Chief Medical Officer.

Every government department would be charged with contributing to improving the nation's health, he said. The release of proceeds from council house sales to build new homes, proposals to get 250,000 young people off the dole and to introduce a national minimum wage were the first steps. "We are committed to a root and branch attack on the things that systematically make our people ill," he said.

Evoking the spirit of an Aneurin Bevan, the NHS's founder, he said that the health service was important not only for the care it provided but also for the principle of fairness it embodied.