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With the 2002 Budget, Labour has simply bought time to reform the provision of health services throughout our society.  But the rescue will not be effected by the mere investment of extra funds – indeed, ill-directed investment could merely entrench vested professional interests still further.  The real challenge of the next decade will be the disempowerment of the medical profession. 

This is bound to sound like Ivan Illich all over again.  In 1976, in his book Limits to Medicine, Illich argued that doctors were part of the problem, not part of any solution.  “The medical establishment,” he wrote, in a ringing paradox, “has become a major threat to health”.  It is the very success of the medical profession that has consolidated, throughout the western Hippocratic societies, a disease-oriented, malfunction-oriented philosophy, literally a pathological view of the world.  Within that framework, the job of the doctor is to identify a malfunction and to cure it, to re-establish a viable equilibrium within the organism.  Doctors “treat disorders” - don't they?  They do.  Indeed, if a condition is “untreatable”, it is not a medical problem. 

Medicines, hospitals, and the philosophies of paramedical professions follow suit.  This system has however proved ineffective promoting positive good health: the NHS is in truth an Ill-Health Service, brought into play when things go wrong.   Within that framework, the dominant influences are the principal Centres of Illness, known as “Hospitals”.  

This must change.  Sports centres are as important as surgeries and health centres. Government must demonstrate that the maintenance of good health is essentially a personal responsibility, albeit with appropriate professional support.  Illness and disability are malfunctions, and if they occur they should of course be addressed by proper medical care, equally accessible to all and free at the point of use.  But the “initiating philosophy” should be about the promotion of good health, not the remediation of ill health.   Nor do the American or Continental systems offer any guide as to what should be done: it is unfortunate that the Government should have given the impression that the problem was merely one of resources.  It is not. Arguably, these other national systems are even more hopelessly in hock to the medical profession than we are.  The Tories are also barking up the wrong tree, with their glorification of foreign parts, equally misguided "foreign" solutions.

The Budget is, therefore, a sideshow.  Our task is to carve out a new, and honoured, role for the medical profession, albeit in a minor key. The profession is, I believe, ready to relinquish its dominant role.  Because of the profession’s successful self-promotion, doctors’ services throughout the Western world are over-used, they are personally over-worked, and certainly over-sued.  Having claimed great efficacy, they are pilloried when their nostrums fail.  The medical professions have been too successful for their own good. 

And in an increasingly egalitarian society, “the Professions” no longer command their earlier social status.  As with lawyers, their numbers have rocketed, their scarcity value reduced, and their distinctive “mysteries” eroded by mass education.  “Doctorates” of all kinds have proliferated throughout society - even dentists call themselves Doctor now.   Finally, even the BMA concedes that many of the profession’s functions could be transferred to Nurses and Pharmacists, with the medical doctor withdrawing to a consultancy role. 

These will be the real changes.  Changes of style, of management, and of philosophy.  But  given human nature, cash will be needed to lubricate the wheels of change.  If these changes can however be achieved, much of the extra money will not be needed at all.

It has now generated the wheeze of putting more young teenagers into prison before trial, just to keep them off the streets.  It has become a byword for repressive and inhumane policies under successive Secretaries of State, Tory and Labour, suggesting that the Sir Humphreys of the Home Office continue to dominate their political masters.  It is a dead, unimaginative and repressive Department of State, which brings discredit to our society.  I hope that Gordon Brown continues to intervene to secure its reform.  It is the duty of Labour not to hand back the Home Office to the Tories in its present unreformed state.