HSJ review of the year: jobless doctors, lethal bugs and a £1.8bn pile of unspent cash

Just as Soviet planning agency Gosplan was notoriously inept at forecasting demand for tractors in Kazakhstan or boots in Siberia, so it is with the Department of Health and the NHS workforce.

The year opened with an HSJ leak revealing that NHS corridors would soon be teeming with consultants (medical ones), while junior doctors, GPs and nurses would be desperately scarce. And if consultants were a glut, allied heath professionals were a swarm - the report predicted an over-supply of 16,000 by 2011.

With the futility of trying to match workforce supply and demand apparent, the report's author was ready to throw in the towel, admitting it may be 'increasingly hard for the DoH to seek to control a fluid, pluralistic market'.

The following week another leaked memo in HSJ revealed the government's goal of halving the 2004 MRSA infection rate might never be achieved. In the finest traditions of the civil service, the document outlined six options: one to tackle the bug and five to handle the PR. The Whitehall sophistry included confusing the public by 'adding something on Clostridium difficile' to the target. Only a civil servant could find an upside to having two superbugs.

March saw some cheer with the abolition of the loathed resource accounting and budgeting system, the financial equivalent of kicking someone when they are down, but the Medical Training Application Service fiasco was also coming to a head. The DoH was forced to admit numerous problems with the system designed to appoint 22,000 doctors from 30,000 candidates. The sight of Conservative leader David Cameron being cheered by thousands of angry doctors marching on Whitehall sent a shudder through the government.

By this time health secretary Patricia Hewitt was widely tipped to be the first Cabinet minister to face defenestration when Gordon Brown became prime minister. Unison was talking about strikes and the government was trying to comprehend how it had invested record sums and give record pay rises while haemorrhaging support from staff and voters.

In April, Sir Ara Darzi - then a mere world-famous surgeon - used his role as national adviser on surgery to press the case for complex operations to be moved to specialist regional centres. The blood curdling title of his report - From Saws and Scalpels to Lasers and Robots - highlighted the impossibility of local hospitals matching the technology or expertise of the best.

The same week Ms Hewitt lamented the way service reconfiguration was bogged down by perceptions that it was about cost-cutting, although having Cabinet ministers campaign against changes in their constituencies hardly helped.

New faces

By late spring, the DoH's new NHS management team was taking shape. The announcement of the new role of NHS medical director marked a shift in power away from chief medical officer Sir Liam Donaldson, already reeling from complicity in the MTAS debacle.

By May, as the decade-long one-man Labour leadership contest ground to its inevitable conclusion, we finally learned Gordon Brown's health priorities included access and, less convincingly, local autonomy.

Before the month was out, the implosion of MTAS had cost James Johnson the chairmanship of the British Medical Association; he was toppled for standing by Sir Liam.

In June, HSJ leaked the plans for the new health regulator. At the time it was still known as Ofcare, but was soon rebadged as the more anodyne Care Quality Commission. Tough powers included criminal charges if hygiene standards were not met.

The same month the health world gathered for its annual jamboree - the NHS Confederation conference - in the concrete wasteland of Docklands' ExCel centre. In a passionate address stripped of flannel and autocue, NHS chief executive David Nicholson called on managers to look out to their communities, not up to the DoH, and promised to try to keep politicians off their backs.

With a new government just days away, the speech fed the optimism of the moment, and delegates returned to their trusts more upbeat than the previous year.

Amid the furore around the change of government, the Cabinet Office attempted to slip out its damning 'capability review' of the DoH without anyone noticing. We did. It exposed failings such as 'greater need for clarity about its role as a department of state'. The DoH promised a turnaround plan in July, then missed its own deadline.

The national media was awash with speculation around Gordon Brown's plan to build 'a government of all the talents'. Sir Ara - soon to be Lord Darzi - became the minister charged with devising a health strategy for the next decade. Mr Brown hoped a clinician at the top of the health service would win back the trust of clinicians and patients.

Everything about the new ministerial team was honed towards reassurance: the dapper, media-savvy Ben Bradshaw, nurse Ann Keen and the personable skilled communicator health secretary Alan Johnson, whose message was a back-to-basics recipe of patient safety, access and tackling inequalities. As the press and opposition rubbished Patricia Hewitt's legacy, she flew to her native Australia to recuperate.

Lord Darzi's review of London added 'polyclinic' to the healthcare lexicon, and exposed him to the hard knocks of party politics, with the Tories accusing him of wanting to kill off district hospitals.

Summer saw the phoney war begin between the government and GPs over access to primary health. Unhelpfully for the government, a survey of over 2 million people on GP services showed more than three-quarters were satisfied.

Autumn marked the arrival of the latest healthcare craze - world class commissioning. Consultations and brainstorming led by DoH director general of commissioning Mark Britnell resulted in a framework to help PCTs 'add life to years and years to life'.

Command and control

Gordon Brown's first party conference speech as prime minister revealed just how quickly he reverts to centralist control when the going gets tough, announcing a 'deep clean' of every hospital, the latest phase in the war on infections.

Back in Whitehall the DoH was getting another drubbing - this time the Commission for Racial Equality said it was the worst-performing department on race. A source told HSJ the department had obstructed every stage of the CRE's investigation.

DoH lights were burning late as Lord Darzi's report was rushed out to clear the decks for the general election that never came. He revealed plans for new GP centres in areas with the poorest services. Shudders ran down the spines of private contractors - GPs - at the thought of other private contractors such as Lloydspharmacy coming in.

October was the month that Maidstone and Tunbridge Wells trust became synonymous with the worst of the health service, with 90 patients dead from C difficile infections. Failures uncovered by the Healthcare Commission included contaminated equipment and patients told to defecate in their beds.

The reputation of NHS managers took a body blow when chief executive Rose Gibb walked away with a£250,000 pay-off - morally it stank but it was probably legally watertight. If not, the Gibb household will just have to fall back on the£170,000 pay-off for Rose's partner, Mark Rees, who within days left as chief executive of Barking, Havering and Redbridge Hospitals trust after running up a£36m deficit.

The Healthcare Commission's health check ratings revealed an overall improvement, but half the trusts languished in the lowest two categories for financial performance and service quality. Many PCTs were struggling.

MPs and the national media were fascinated by HSJ's revelation in November that the NHS was heading for a£1.8bn underspend. Ben Bradshaw welcomed the 'excellent news' but PCTs knew better, and strategic health authorities redoubled efforts to get them to spend. Like the rest of us, they are throwing money around at Christmas.

So, what of 2008? The year will see the unveiling of Lord Darzi's strategy, the social care green paper, PCTs trying to become expert commissioners, more reconfiguration rows and the private sector starting to plug the gaping holes in GP services. By healthcare standards, it sounds rather quiet.