Last week saw the publication of a series of reports on the role of the Department of Health and the management of the new NHS (see p 357).1 These reports were commissioned in the light of the functions and manpower review and the decision to abolish regional health authorities and merge district health authorities and family health services authorities.2 The result of ministerial deliberations and Treasury intervention will be a substantial reduction in the number of civil servants in the Department of Health. There will also be tight controls over the number of staff employed in the new regional offices of the NHS Executive and a move to accelerate joint commissioning between district health authorities and family health services authorities. This all adds up to a further period of major structural change as the government seeks to get the organisation right.

While many of the planned changes are sensible in their own right, taken together they will undoubtedly divert scarce managerial time and attention away from the real issues facing the health services. These are less to do with structure and management than with the future direction of the NHS itself. As things stand, there is no coherent strategy guiding the development of the NHS and there is a suspicion that the current occupants of Richmond House are not much interested in developing one. Tactics have come to dominate strategy, and ministers have seemed more concerned with keeping the NHS out of the headlines than with articulating a clear vision for the future.

Some people will argue that this is unfair and ignores the health strategy set out in the The Health of the Nation3 for England and in its sister documents for the rest …