On the way to Calvary

Ministers should realise the command and control model the white paper entails

What is surprising about the government's plans for the reform of the NHS in England is not what is in the white paper1 but what is omitted. The white paper was a triumph of style over content, which temporarily convinced a sympathetic profession and the wider public that all would be well for the NHS under Labour. Now the presentational triumph is over, come the pains of implementation, and ministers may find that they have unintentionally nailed themselves to a cross. For what is implicit in the white paper, but not spelt out, is that if the policies outlined in it are to succeed central government will have to play a more active role, managing and directing change.

The Conservative reforms of 1991 were intended to diffuse blame to the market. In practice, politics dragged ministers back, as the market was never allowed free play. The new Labour plans will, in contrast, focus on ministers. For implicit in the white paper is a command and control model of central management which …