Decades of under-investment had left Britain's finest post-war achievement in a potentially critical condition, and on a very long waiting list for surgery.

It took Labour three years to realise the extent of the surgery that was required. Since then, billions of taxpayers' cash has been poured into sorting out what were essentially problems of capacity.

Investment in more doctors, more nurses, more drugs, modern hospitals and better equipment will, for instance, have driven down waiting times from as long as 18 months to a maximum of 18 weeks by the end of the year.

The speed of the changes, at least in health service terms, has beendramatic but until now it has been achieved by a combination of extra cash and controversial Government targets, rightly criticised for being crude, but inevitable given the scale of public investment and the political capital tied up with them.

Yet despite the investment which now sees £8bn spent each year on the NHS in Yorkshire – three times more than a decade ago – unacceptable problems remain, particularly in the serious health inequalities between the richest and poorest which sees life expectancy
in parts of the region vary by as much as 14 years between people living just a few miles apart.

Ministers now believe the foundations of the NHS have been secured and yesterday, through Lord Darzi's report, they set out a vision which they believe will tackle these remaining problems by focusing on improving the quality of care available.

For the first time in 60 years, it appears to mark a decisive shift in power out of Whitehall and into local GP surgeries and even to patients
themselves.

In part, it reflects the reality of the health of the nation. The population is ageing. People are living longer, but living with diseases of old age.


Increasing obesity, which in Yorkshire could mean two-thirds of babies born in 2000 will be obese by 2050, is storing up a surge in heart ailments, cancer and diabetes in the future.

Tackling and treating these problems cannot be led by politicians, but only by co-ordinated and innovative work led by family doctors, community nurses and social health teams based in their communities as well as people taking responsibility for their own health and fitness.

The ambition is for the NHS to switch from a sickness service to one of wellness. In Yorkshire, it will mean a particular focus on deprived communities, traditionally those which are hardest to reach with public health messages, but where the health gains could be the most significant.

But the move away from Whitehall also reflects another reality of 21st century life. Just as consumers now have unprecedented choice about where they shop, go on holiday or which car they run, NHS patients used to a take-it-or-leave-it service are being offered personal care for the first time, notably with a choice over their treatment.

This means not just a choice of hospital, but also a wider choice of GP. Patients who find their GP repeatedly fails to offer them a convenient and speedy appointment might well head down the road to another surgery, while those less than impressed about results for hip surgery at their hospital can instead travel to their further afield for an operation.

Until now, patients have been denied the information they
need to make important decisions over their healthcare. Under the new plans, vital information will be readily available about how well a
local GP or hospital is doing not just in terms of treatment outcomes, but also including ratings about dignity and even levels of compassion shown by staff.

Provided frontline staff are given the tools to be able to improve standards, then this could prove a huge breakthrough for doctors and nurses who have complained for so long about suffering under the yoke of Government targets by giving them a real chance to enhance the quality of patient care.

And, in theory, greater consumer power and competition should drive up standards. But while no one will much miss those high street shops that fail to attract customers, it is not the same for local doctors or hospitals that fail to make the grade.

There are still real dangers that some patients – usually those most in need and most vulnerable, who are unable or unwilling to exercise choice – will lose out from sub-standard care. It even raises the prospect of unpopular hospitals slowly losing staff and services until they are no longer viable.

There are also dangers about handing control of budgets to patients with long-term conditions. Those best equipped to work the system
to their advantage will get better care, potentially undermining the founding principle of the NHS that care should be equitable.

In introducing its reforms, Ministers are setting out measures which give patients and frontline staff real power and, most importantly, the kind of information that has been long-needed to drive up standards in the NHS.

But, in unleashing competition, they need to make sure the disadvantaged – both people and institutions – are not left behind, further entrenching the very inequalities that the Government seeks to eliminate.



THE BEST OF HEALTH NEWS


From tomorrow, the new "Health Info" section on the Yorkshire Post website will be brought to you by NHS Choices – the Department of Health approved health website.

Each day it will provide unbiased and evidence-based analysis of health stories that are making the news.

All articles will draw on the knowledge and expertise of the National Library of Health, NHS Direct, the Information Centre for Health and Social Care, the Healthcare Commission and many other trusted health organisations.

Visit the new section at yorkshirepost.co.uk every day to find out the facts behind the headlines.

Mike Waites is the Yorkshire Post's health correspondent.