Jan Williams, chief executive of Iechyd Morgannwyg HA, tried hard not to sound too pessimistic about the future of Welsh HAs under a National Assembly.

She argued that the assembly and health services would find themselves in a 'marriage'. If it was 'for better', assembly members would take a strategic approach to healthcare and tackle deep-rooted inequalities. They would 'open up the secret garden of the NHS to the outside world' and drive up performance, develop a 'sustainable' financial framework for the service, and recognise the need for 'strong and effective management of the NHS'.

But the marriage could also be 'for worse'. If it was, Ms Williams argued, parochialism would worsen as assembly members fought for their patches and 'politicians rush to bring to Wales services that it cannot really sustain'.

The 'radical, reforming agenda' of the white and green papers would 'vanish under the weight of the monopoly powers of acute providers' and opportunities to develop primary care and tackle inequalities would be lost. In either case, she argued, HAs were going to have to be more open and recognise that levels of decision-making would change.

The Welsh Assembly will take over the work of the Welsh Office and allocate its budget of pounds 7bn a year, pounds 2.7bn of which is presently spent on health. The assembly will be led by a first secretary ('the equivalent of a prime minister'), supported by an executive committee and assembly secretaries ('ministers') responsible for six policy areas.

But the UK Parliament will still have a secretary of state for Wales.

'The Welsh Office is going to want to take itself some of the decisions HAs are currently involved in making,' said Ms Williams. 'There is also no doubt it will put a more distinct stamp on Welsh services. They will diverge further from English models of care.'