opinion

In the first three months of 1999, the Department of Health issued 86 health service circulars and 188 press releases. This is an average of three press releases and getting on for one-and-a-half circulars per working day. The NHS, the media and the public are being deluged with priorities, innovations and other policy wheezes.

The word priority has been thoroughly abused. The dictionary defines it as 'claim to consideration as first'. But not every policy priority can be equal first, particularly when their costs are not estimated and the evidence base is often frail.

Civil service mandarins assure us that this is an ambitious and impatient government.

It is also a government with little experience of governing, served by a civil service which should advise cautiously rather than break into a gallop with its political masters. The risk is that they will all take the NHS over the cliff into fragmentation.

Their behaviour brings to mind MP Tony Benn's view: 'The civil service is a bit like a rusty weathercock. It moves with opinion, then it stays where it is until another wind moves it in a different direction'. Clearly, the weathercock has shifted, and mandarins are 'rusted in' to another mania.

The ministers themselves are well intentioned and much in awe of President Blur's Downing Street machine. There Robert Hills, the prime minister' s adviser on health policy, wields considerable and unconstitutional power. He revises both the grammar (or is it the Microsoft grammar checker they use?) and the content of policy documents, which are then often distributed on behalf of the DoH without its ministers seeing the final draft.

Potential critics outside government are brought into the fold either by telephone conversations with civil servants and ministers prior to 'innovative' policy announcements, or by involvement in the launches. Better to have such folk in the tent peeing out than outside peeing in. Leaders of national organisations have been known to roll over and be tickled by a call from Dobbo in the middle of the night.

For democrats, the worry is that it blunts the critical faculties of would-be independent commentators and leads to poor policy formulation.

This democratic deficit is heightened by careful NHS policy. On the one hand the government deplores the 'evil' Tory policy of 'gagging' NHS employees because that, amongst other things, led to the Bristol problems.

But the firm message to NHS managers now is to toe the party line, be on-message and do nothing to initiate and fuel 'bad news' stories. In part this compliance is achieved by official 'cuddling' of national organisations by the deployment of honours and other totally merited favours. Many positions - for example, being president of a royal college, bring with them a knighthood or damehood, and to place these in peril by independence and being 'off-message' would never do.

The government line is that the comprehensive spending review financial settlement was generous. And so it was - almost as generous as that given by the Tories in the early 1990s, when we last re-disorganised the NHS.

However, Labour is demanding even more change in the NHS than its Tory predecessors. Well, nowt wrong with that if it is prioritised and funded. The problem is that the deluge of government policies has spent, re-spent and spent again the 'generous financial settlement'.

Many purchasers have followed government orders and committed themselves to policies, which they cannot now afford. Providers with 'gaps' between income and expenditure are being told that there is no more money and they have to meet all service commitments.

These include expensive and poorly costed programmes such as Calman-Hine (cancer), waiting list and times targets, forthcoming outpatient waiting targets, forthcoming coronary and mental health service frameworks, guidelines from the National Institute for Clinical Excellence, clinical governance and the interesting effects of a 'consultant-based' NHS and the EU's 48- hour working week.

Then, of course, there is the slight matter of NHS reform to be implemented, with primary care groups (60 moving to trust status in April 2000) and the creation of mental health trusts, NICE and the Commission for Health Improvement all at no extra managerial costs.

Any protests about the 'achievability' of this programme is met by rhetoric on the generous financial settlement, and, quietly, instructions to 'prioritise'.

'Do you mean 'ration', guv?'

'Certainly not,' say the zombies from Whitehall and region. 'We mean prioritise - and don't cut any services.'

So the Blair government would like rapid, unevaluated change, enforced by threats of being 'outed' as off-message if there are protests. This is a nice social experiment. Managers and all professionals will strive to oblige, putting their health and that of the NHS in jeopardy.

So stay sane as ministers deluge us with press releases and circulars, and comrades in No 10 manufacture more 'good news', which a compliant press and public will swallow far too uncritically.

As the conference season approaches, how will the professional organisations, such as the NHS Confederation, the Institute of Health Services Management, the British Medical Association and the Royal College of Nursing, respond to this policy process? Will they 'toe the party line' with yawning complacency, sending their audiences to sleep?

Or will they exhibit some independence, and lead a critical debate of the intent and process of 'New Labour's' healthcare reforms? Perhaps we can guess, and settle down to a quiet snooze instead by the sea or in some spa town.