So just where do we go from here?; THE FUTURE OF THE NHS

DAY SIX: In the final part of our series, Virginia Bottomley sets out her vision, as Labour says no new cash will be pledged ahead of a general election. Alex Carlile revises the Liberal Democrats' stance, while Alan Langlands, chief executive of the NHS, says there are parts of ther reforms that no one should change

Virginia Bottomley, the Secretary of State for Health, writes:

The National Health Service is perhaps the single most powerful idea to have been conceived in Britain this century. It was born because, in the words of Iain Macleod, "we are all equal in the face of illness". The idea of a health service available to all, regardless of ability to pay, touches the deepest British instincts for humanity, equity and justice.

Today we wrestle with the dilemmas brought about by the success of the NHS - a population living longer and with ever greater expectations and demands. Despite this, the political consensus in its support remains broad, deep and enduring. It expresses the special relationship between the public and their NHS.

Like all relationships there is a danger of this one becoming strained. Public satisfaction with the NHS, though rising again according to the British Social Attitudes Survey, and very high among those with specific experience of the service, remains generally below the levels of the past. Patients are increasingly knowledgeable, assertive and ready to complain. And they are suspicious of change.

We must neither reject the fundamental principles on which the NHS was founded nor resist the natural process of evolution which scientific and medical advance brings. Strengthening the NHS can only be achieved by blending a commitment to the traditions of the service with a willingness to face up to the need for change.

The health reforms preserved the founding principles of the NHS. However, they have also established a new and better way of running the NHS.

In place of the fossilising web of central bureaucracy has come a fresh emphasis on local energy and effort. The focal point of decision-making shifted into the hospitals, clinics and surgeries where the people are. The new NHS should be a celebration of diversity and innovation, not a monochrome vision of incremental change.

This new NHS is united by common goals. Its core values are a commitment to patients, to improve the health of the nation, to supporting research and focusing on clinical outcomes. We have a policy framework - the reforms; the Patient's Charter; our research and development strategy; the Health of the Nation White Paper - for translating these values into practice.

In implementing this programme we should take a long-term and strategic view. The heart of the new system is the purchaser/provider relationship. As that relationship matures, I want to see purchasing become more sophisticated. Decisions should be motivated by long-term improvements in quality, in health and in meeting needs. I would like to see greater use of long-term contracts between health authorities, fundholders and NHS Trusts.

It ought to be possible to develop a new political consensus around these ideas. However, as the Independent has revealed, the Labour Party has other plans. It is obsessed with slogans about "renationalising" the NHS and committed to regressive policies including the abolition of fundholding and NHS Trusts. Though there are the unmistakable signs of a Labour fudge - for example in the idea of giving GPs "national budgets" - the proposal is basically a return to central control.

Such upheaval would be sheer folly. It would divert energy from the real task that faces the NHS and its allies - to use the potential of the new system to meet the challenges ahead.

There are three features which should, above all, define the NHS of the future: innovative; efficient and responsive to patients.

An innovative health service means recognising that we are facing, and will gain from, an exponential advance in clinical knowledge and technology. The delivery of services will increasingly come to be based on what achieves the best clinical outcome and a more knowledgeable public will increasingly ask questions about the quality of care as well as its accessibility.

We have in our pioneering R&D strategy, our work on clinical audit and effectiveness bulletins a means of garnering knowledge about what treatments work best for patients. This will ensure the NHS remains innovative as medical science advances. It will feed in directly to the setting of contracts between purchasers and providers and determine priorities. It is potentially the most far-reaching of all this Government's health reforms.

In a world where ever greater demands and expectations chase finite sums of money, no one can afford to ignore the need for efficiency. Eliminating wasteful practices will be vital to preserving the NHS at a cost the nation can afford. We have to drive out inefficient and out-dated working customs. Local pay can, and will, support this.

We are becoming more efficient in how staff are used. The new NHS provides many more opportunities for them to develop and use their skills in different settings. Traditional demarcation lines are breaking down.

I am confident about the future of the NHS. Thanks to our reforms it is now better prepared to meet the challenges ahead.

My ambition for its future echoes the words of Disraeli, the political father of public health policy, who said: "Not insensible to the principle of progress, I have endeavoured to reconcile change with the respect for tradition which is one of the main elements of our social strength." Continuity and change: in that lies the future of a stronger, better and lasting health service.