Focus pocus or change?

After 18 years under the Conservatives, Labour's promises included an open and honest style, the end of the 'internal market', the abolition of GP fundholding and reductions in waiting lists.

The open and honest style was trumpeted throughout the run-up to the election as a key issue for Labour. Despite this, the election campaign was the most slick and centrally controlled ever. Signs suggest that the much lauded open style is not so certain.

Take the role of the regional office. How many of us remember the famous 'light touch' promised by the slimmed-down regions?

Under The New NHS white paper, regional offices are in danger of becoming little more than the Department of Health's thought police. They are now staffed by civil servants, whose primary task is to cover ministers' backs.

These civil servants will be the key people who have to deliver the centre's policy agenda.

Already the regional offices are making it plain they will call crucial shots. Witness the recent edict from many regions that they will insist on a seat as external assessors in all trust chief executive appointments.

Yet these same civil servants want to have their cake and eat it when it comes to accountability.

For a clear example, read the transcripts of evidence given to the Fallon inquiry into Ashworth Hospital by NHS chief executive Alan Langlands and North West regional director Robert Tinston. Here you will find almost Orwellian double-speak, lacking any clarity about who is accountable for what.

It sometimes seems that those at the top will accept responsibility when all is well. When things go wrong they appear to have the option of hiding in constitutional niceties. Former health secretary Virginia Bottomley once confessed she had made an error in abolishing the regional health authorities. I have a feeling that may prove to be the understatement of the decade.

I recently wrote an article in a national newspaper analysing the decisions on reconfiguring London hospitals. Some of my remarks were blunt and not at all kind to the current government.

A number of chief executives phoned to thank me for my frankness, and agreed with my views.

I asked them why they did not speak out in a similar manner. Their answers were consistent: they were afraid.

Two told me that life under 'this lot' was actually worse than life under the 'last lot', and that the NHS Executive made it plain that chief executives were expected to toe the line. If this is an open style, I am the pope.

Before The New NHS white paper we were assured that the internal market and GP fundholding would go. We now know that the essential cornerstone of the Tory reforms - the commissioner-provider split - is intact, albeit in a different framework.

The new government could not be seen to have an early bust-up with BMA House, so a way had to be found to keep the GPs on board. The solution was primary care commissioning groups, in which current GP fundholders could end up with a lot more power.

The government is extremely smart to include these ideas in its armoury; I just wish that it was more honest with the public and those who have to manage the NHS.

We expected Labour to continue with the mantra started - to his shame - by the then health secretary under the Conservatives, Stephen Dorrell, of 'white coats good, grey suits bad'.

Hansard and election briefings are littered with promises to cut the NHS's transaction costs.

Most NHS managers would not disagree, and might have some good ideas to save money. But nobody in the new administration has asked them. Government by soundbite and the idea of pleasing the lowest common denominator seem to be the order of the day.

Look at the totem poles ministers have decided to dance around: waiting lists are a classic example.

To read the press, you could be forgiven for thinking they are the crucial measure of success, yet acute hospitals face far bigger challenges.

In mental health, the unseemly ministerial urge to jump on the bandwagon of public safety has led a Labour secretary of state to declare to the Tory Daily Telegraph that 'care in the community for the mentally ill has failed'.

We are in real danger of policy being formulated around the latest idea to emerge from a focus group, the needs of Mandelson Towers and what politicians think will curry favour with the tabloids. So far, this is a disappointment. Those of us who woke on 2 May last year, having voted Labour, saw a government with a huge majority, and hoped it would lead to brave policies which would challenge the status quo.

Managers were as worn down as the rest of the NHS's staff by the previous administration's dishonesty. They were - and still are - prepared to serve the new government with energy and commitment if the policies are right.

The jury is out. Prime minister Tony Blair has talked about the need for humility in government. If ministers and their officials interpret his views to mean the creation of an illusion of humility, they will risk squandering the trust and commitment of those who manage the NHS.

Weasel words from spin doctors and officials in the DoH and the NHS Executive will prove no substitute for honesty and integrity in the leadership of the NHS.