Published: 27/05/2004, Volume II4, No. 5907 Page 12 13

Set to leave Number 10 for the considerably more lucrative world of United Health Group, Tony Blair's special policy adviser on health, Simon Stevens, has set out his views on the progress of the UK's health reforms in US journal Health Affairs.

He identifies three types of reforms: one-dimensional, or support for providers, which includes increasing the supply of health professionals and modernising infrastructure; two-dimensional, or hierarchical challenge, which includes target-setting, performance indicators and inspection; and three-dimensional, or localist challenge, which includes patient choice and pluralism.

He concludes that a threedimensional reform model is needed in a complex sector such as healthcare, which in England's case corresponds to the 'triangular relationship between the British state, the medical profession, and the public'.

Meanwhile, the introduction of the payment by results system a year ahead of the rest of the NHS by the majority of the 10 first-wave foundation trusts has attracted criticism from senior figures throughout the service.

But specialist trust chief executives may have succeeded in making their voices heard Department of Health group director of health and social care delivery John Bacon told the Commons health select committee that it was 'not inconceivable' that the DoH may have to find a way to support specialist trusts 'over a period of time', as well as receiving a one-off payment in the scheme's first year.

He said this demand had 'came out very strongly' from the payment by results consultation.