The right principles but bedevilled by the detail

Before last year's election the Labour Party made much of its intention to move away from the fragmentation allegedly caused by the previous government's NHS reforms and to return to a truly national health service. However, as the new government's proposals have been revealed, it is all too apparent that its commitment to devolution exceeds its commitment to the recreation of a national service. The differences in the organisation and nature of the service between the four parts of the United Kingdom are to be increased, and in particular health care in Scotland will diverge, with complete exclusion of general practitioners from the process of commissioning care.

Over the past six months a succession of white and green papers have spelt out the proposals for NHS reform1^–4and strategic improvements in public health.5^–7 These have emphasised a service that is fairer, distributes resources more equitably, eliminates two tierism, is needs led, better integrates health and social services, is based on cooperation rather than competition, reinstates strategic planning, emphasises quality, addresses health inequalities, promotes better health, and involves the public. Thus, at the headline level, the proposals have secured wide endorsement, from both the public and health professions.

However, it has been all too apparent that the detail has …