The 60th birthday of the NHS has been talked about for so long that you could be forgiven if, like me, you thought it was going to be last year. 2008 was only a few days old when both party leaders flashed their health policy credentials.

Prime minister Gordon Brown said the "renewal of the NHS" would be Labour's highest priority, while David Cameron somewhat ambitiously said he wanted to replace Labour as "the party for the NHS" in 2008.

The policy gurus in Downing Street clearly decided to get their heads down over Christmas. Gordon Brown's speech at the start of January was full of strategy, populist themes and some good ideas for immediate implementation, such as enhanced screening (no matter how many times this has been announced before).

But what is the point of Labour's "once in a lifetime" review of the NHS if they are going to politically second guess the strategic findings? The answer, as always in politics, is that this was the week of a prime ministerial relaunch.

The interim Darzi review was an anticlimax, with the delivery nothing close to the rhetoric.

Reform on the agenda

Last year saw a renewed cancer plan and stroke strategy, and obesity and alcohol plans may soon follow. The quality and outcomes framework will have its inevitable two-yearly spring clean and the operating framework has already given the green light to polyclinics, commissioning reforms and accessibility issues.

The problems will be in the delivery, as they have been for the past 10 years. It is difficult to see why much of this has taken so long to achieve. The research into aortic aneurysms, including the cost-benefit analysis, demonstrated this was a no-brainer back in 2005. Cardiovascular screening in over 55s has potentially the strongest research base in any element of the GP quality and outcomes framework yet was vetoed in 2006 on the grounds of cost. And let's not forget that Saturday surgeries and the over-65 health check were undone by the introduction of the GP contract in 2004.

If I were Lord Darzi I would be very worried indeed - being left with the dirty laundry of closing a trauma centre in his own hospital and enforcing polyclinics throughout London will not be popular and anything less will undermine the rhetoric and promise of the past six months.

A harsh lesson in ministerial accountability is sure to ensue, while the race for party credibility with the NHS is sure to be closely contested.

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