If nothing else, 1998 will be a landmark for the NHS. Its year- long 50th birthday party starts this month, even though the balloons and birthday cake will have to wait for the celebrations which will mark the first 'NHS Week' in July. The mood is deliberately upbeat, but for staff and managers who feel ground down and demoralised, will all the celebratory hullabaloo ring hollow?

I hope not. In an environment that's changing constantly, it's always difficult to celebrate success. The 'reinvention' of the NHS through successive reforms may have taken its toll on employees, but loyalty and commitment have always been the hallmarks of NHS staff. If plans to mark the 50th anniversary achieve nothing else, reminding politicians and the public of that energy and commitment will be a considerable achievement.

Of course, the big question posed by the celebrations will be, 'Will the NHS survive another 50 years?' Again, I'm inclined to be positive. The NHS has always had more than its fair share of detractors and doom merchants. Talking about it as a funding black hole doesn't just send the Treasury into a spin, it promulgates the image of a drain on society rather than a dynamic and efficient public service run by a highly motivated group of professionals. That ability to change has enabled the NHS to survive. What's certain is that the NHS of 2048 - if it exists - will offer a different kind of service to a different kind of public.

Back in 1948, the prognosis for very sick patients was poor. As medical science offered few solutions, good nursing care was often their best route to recovery. It might seem odd, then, that while medical knowledge has expanded, the last 50 years have also been crucial in the history of nursing.

The changes in nursing since the creation of the NHS are unprecedented; never before has the pace of change been so fast. Looking forward optimistically in 1948, the then president of the Royal College of Nursing, Dame Louise Wilkinson, was justly confident that things would be different: 'Nursing has allowed itself in the past to be taken too much for granted. We have allowed ourselves to be handmaidens of the medical profession. Nurses have not got the slightest intention of accepting a lower plane than that of an active, loyal and wide-awake partnership with the medical team.'

Discussions about the boundaries of nurses' roles were nothing new, even in 1948. As with medicine, technological improvements and advances in drug therapies caused a marked change in nursing practice. Although new equipment like heart-lung machines and respirators made it possible to treat diseases which were previously incurable, the new technology was expensive and highlighted the need to keep costs down. Patients no longer recovered in hospital for weeks on end, and shorter patient stays led many nurses to question some of the hallowed ward routines they had inherited. As the ward atmosphere gradually became more informal, waking patients at 6am to make their beds began to fall out of favour.

In what will no doubt be the first of many accounts of 50 years of the NHS, Geoffrey Rivett's book, From Cradle to Grave, published last week by the King's Fund, plots these and other key developments in nursing well. Rivett demonstrates how nurses - often invisible in the history books - have helped to shape the health service. Yet in distinguishing itself from medicine, Rivett fears that nursing has left itself dangerously exposed. He claims that nursing's acceptance of medical leadership came complete with all the advantages of medicine's protection.

As we look to the future, perhaps one of the great advantages of the modern NHS is that it recognises that the health service is a partnership business - a partnership with patients and a partnership between different members of the healthcare team.

The New NHS white paper demonstrates how far nurses have come in 50 years. Far from being handmaidens, nurses now have the opportunity to shape as well as deliver the healthcare of the future. The government's recognition of nurses' value is long overdue, but the white paper offers much more than rhetoric.

For the first time since the reforms, nurses will be actively involved in commissioning NHS services through the new primary care groups. Involving nurses in commissioning makes good common sense. Community nurses are ideally placed to assess local health needs, inform purchasing decisions and evaluate the delivery of services. It's only natural that the expert nurses who hold some of the most intimate knowledge about patients should be involved in the planning as well as the delivery of primary healthcare.

The first 50 years of the NHS have not always been easy for nurses, but throughout its history nurses have remained committed to a universal health service, free at the point of delivery. Nurses have worked hard to prove their value, but, ultimately, the NHS has provided nurses with an environment where they can flourish, where they have been able to expand the scope of their practice and explore new ways to improve the quality of patient care.

As medical science continues to expand our understanding of what is possible, the key question in healthcare is no longer, 'Can you cure me, doctor?' As our understanding of what constitutes healthcare shifts focus, patients may not necessarily welcome an increase in medical intervention at the expense of quality of life. What seems certain is that those skills of caring, communication and disease prevention - skills which have traditionally been the domain of the nurse - will become increasingly important for all health professionals. Perhaps for the patients of the next century, the key question will not be, 'Can you cure me, doctor?' but, 'What are my options, nurse?'

Christine Hancock is general secretary of the Royal College of Nursing.

'The New NHS white paper demonstrates how far nurses have come in 50 years. Far from being handmaidens, nurses now have the opportunity to shape as well as deliver the healthcare of the future... Involving nurses in commissioning makes good common sense'