NHS reform sets out big challenges

Ensuring the future of an effective National Health Service is the biggest challenge the government faces. Last week's NHS Plan is far-sighted, but long after it has been consigned to the archives, the NHS will still be swaying the outcome of general elections.

With declining public spending in other fields, the NHS dominates budgets. In 2001-02 it will cost more than Pounds 45 billion, almost three times as much as central government spending on education and employment and equal to all education spending, local and national. It costs twice as much as defence, with which it was level-pegging a decade ago.

But the future of the NHS is about people rather than money. Expectations of NHS staff continue to grow. Higher education is the unique provider of these professionals and is central to the future of the NHS. A decade from now, if the plan works, doctors and nurses will be only two of many groups sharing elements of both higher education and lifelong professional development. Universities have responded with enthusiasm to recent changes in the NHS, which have involved more students and more money. But now they are being asked to participate in creating new types of staff, under novel conditions including substantial common content for everyone from surgeons to primary mental healthcare workers.

These changes are coming when the old system is under severe strain. Common-approach teaching must not simply mean bigger classes. If nurses are to take on some tasks now performed by doctors, they will need more of the knowledge that doctors have. Many health schools, especially in new universities, do not teach doctors. Will their nurses be regarded as less able to substitute for doctors because they have come through a lower-esteem educational route?

The staff who will deliver the new NHS to patients will also have to cope with a high rate of innovation and new forms of screening and prevention. They will have to be able to cope with ethical issues such as those raised by our new knowledge of the human genome. So they will need to be in touch with an active research base and first-class scholarship, during their full-time education and into their careers. Although Britain's best medical research is equal to any, the need to broaden it geographically and in scope should form a central part of higher education's response to the NHS Plan.