Managers may have their performance partly measured against national health promotion targets, according to a Department of Health document.

These would relate to 'issues of high public concern', such as waiting times for surgery, as well as conditions with high death rates like heart disease, stroke, and certain cancers. Public health experts fear the targets would ignore the contribution of other agencies to health promotion.

Scottish health boards have been asked to submit plans for separating their purchaser and provider functions. A circular has proposed board membership be cut from 24 to 12, of whom a maximum of four should be executive members.

Scottish health minister Michael Forsyth is facing resistance to his proposal to cut the number of local health councils to one per board.

The NHS policy board's work is too secretive, according to the Institute of Health Services Management and National Association of Health Authorities and Trusts. 'It is quite difficult, from where most people sit, to know what the hell the policy board is for, 'said IHSM director Pamela Charlwood. Board member Baroness Cumberlege admitted that former health secretary Kenneth Clarke had neglected it.

Health authorities could be forced to choose between keeping services running and paying victims of medical accidents unless the compensation system is reformed 'sooner rather than later', said King's Fund College fellow Dr Chris Ham. He said many HA treasurers were already setting aside reserves for anticipated claims. 'Whether these will be adequate, no-one can predict. '

The NHS and the private sector should increase cooperation to make best use of the internal market reforms, NAHAT says. It also wants HAs to set up their own recruitment agencies for nurses, doctors and paramedics.