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Talking of Nye Bevan, he of course is to blame for three generations of political blood, sweat and tears as politicians try to bring doctors properly to account for the impact of their decisions, clinical, managerial and financial, and to provide direction and development in the NHS which is in the best interests of the citizens who pay for it. The current "reforms" are their latest attempt and good luck to them.

Of course, politicians have been their own worst enemies in this process. They have failed to empower other professionals in the NHS, managers in particular. They have given free rein to their irresistable urge to interfere in nitty gritty whilst failing lamentably to give coherent strategic direction. The combative rather than co-operative politics they have fostered in Britain has defined continuity and consistency as dirty words and condemned the NHS to major and mostly unjustifiable disruption after every general election.

The underlying conviction of the politcal establishment has been and remains that they will only get what they want if they excercise strong central control. The attempt has been made in the past to camouflage this with fine words and shallow gestures about freedom, clinical leadership and localism and so on. And so it is now. Sadly,it is as unlikely as it has been since 1948 that we shall now get that framework of transparency, progress and development in our Health Service, with accountablity between doctors and the citizen, that should be the mark of a civilized society.

But there is one crumb of comfort for those who care for the NHS in England. At least something is happening to try and make your NHS fit for purpose in the 21 century and there is a process in which you can be involved and which you can try and influence. Elsewhere in the UK, heads are still very firmly buried in the sand.