Managers fear Northern Ireland's unique experience of joint health and social services may be under threat. Pat Healy reports

It was probably a wise move to set out the government's vision for the future of health services in Northern Ireland in a consultation document rather than a white paper.

For the 250 responses to Fit for the Future vary so widely that they beg the question of whether its proposals have a future.

Consultation has now closed, and no white paper is expected until the Northern Ireland assembly starts work next February.

But managers and staff appear to agree on one thing only: they welcome the document's principles as the basis for reshaping health and social services. However, no one wants to pick up either of the two models offered to replace the internal market - the British Medical Association is even offering a 'third way'.

And there is a widespread feeling that the cart is being put before the horse, since decisions will be taken by the new assembly - which may take a much broader view of how public services should be changed.

There are also concerns about the proposals themselves. A common view is that they could undermine the 25-year-old system of integrated health and social care, despite the document's assurance that integration will continue.

This is partly because of fears that a proposal to devolve commissioning to primary care groups could lead to the transfer to Northern Ireland of the British experience of domination by doctors.

But there is also concern that the consultation document is too closely modelled on the white papers for the rest of the UK, and ignores the Northern Ireland experience of joint working.

Northern health and social services board says pointedly: 'It is critical that changes are not contemplated which would result in the disestablishment of existing networks.'

That would be both wasteful and likely to undo 'the significant progress that already has been achieved in addressing inequalities and securing co-ordinated planning for the social well-being of the population'.

Chief executive Stuart McDonnell says the way health and social services work together in Northern Ireland is unique, and he is disappointed that the document does not address significant social services issues.

He believes that if structures are to be changed, then further integration with other services, such as education, probation and the police, is what's needed - a view that is widely shared.

Multi-agency working is much more advanced in Northern Ireland, he says. A purely medical model would not fit well with the experience of the past 25 years.

Southern board suggests picking up parts of both models offered in the document, which chief executive Brendan Cunningham says does not go far enough in involving communities.

'We have a health action zone in which we are starting to build good relations with education, local councils and GPs. Certainly we want to ensure that whatever structures are put in place will allow these local agencies to join up their thinking.'

Similar views are offered by Eastern board, which says the document 'did not celebrate sufficiently the unique advantages in Northern Ireland of having integrated health and social services combined with the advantages of continuity between hospital and community care.'

The board adds: 'More priority might have been given to building on existing links between health and social care to make them more joined up with education, housing, economic development or other aspects of service provision which have a significant impact on the health and well-being of the population.'

Eastern board wants the basic building block of any change to be 'the natural local community', a point made by others who say the continuing divisions in Northern Ireland make planning on the basis of GP practice populations unrealistic.

Western board wants change only 'where it can be clearly shown to benefit patients, clients and communities', and calls for greater accountability in any new authority, whose members should include councillors and representatives of local communities, voluntary organisations and professionals.

But chair Robert Toland says it is vital that any change in how health and social services are organised should be in tune with the transformation of government and public service taking place in Nor thern Ireland.

Little is clear about how those new arrangements will work. The political parties are each suggesting different numbers and combinations of government departments to run services.

It is expected that the assembly will want to review public services, either by examining them broadly across the present departments or through a more limited incremental approach.

Either way, progress on Fit for the Future or its successor seems a long way off.