Huge shake-up to keep founding aims intact

The widely trailed document is expected to open with a foreword restating the government's commitment to the founding principles of the NHS - a 'statement of vision'key stakeholders have been encouraged to sign up to.

It will also 'firmly reject' a move towards private medical insurance, in an extension of the government's ongoing attack on Conservative health policy.

But the plan will also call for fundamental reform. Mr Blair said last week that the NHS was a '1940s service operating in a 21st century world'.

Exactly the same phrase was used by health secretary Alan Milburn in a weekend television interview.

Headline-catching promises will include plans to halve the maximum waiting time for operations to nine months within five years, coupled with a guarantee that cancelled operations will be carried out within 28 days within two years.

HSJ understands Mr Milburn fought fiercely for more money from the Treasury to deliver shorter waits for operations more quickly. The relatively unambitious waiting-time targets suggest he has been forced to settle for targets that can be delivered within existing NHS capacity, bolstered by 'thousands' of extra staff, some of whom will have to be recruited from abroad. The plan will also set out proposals for patient advocacy and liaison teams (PALS) for hospitals and promise a 'war' on mixed-sex wards, dirty conditions and poor food.

'Patients today are just not going to accept that they have to wait months and months for appointments and operations, ' Mr Blair said last week.

Other aspects of the plan are expected to include:

a guarantee that patients will be able to see 'a health professional' at their GP surgery within 24 hours and a doctor within two days, incentives for GPs to practise in deprived areas and money to expand surgery services;

a new focus on mental health, including 1,000 extraclinical psychologists to help people deal with anxiety, panic attacks and similar problems;

moves to end rigid demarcations between staff groups;

'supertrusts' to take over social care for elderly people, with the possibility that the NHS could also take over other social services;

a response to the Royal Commission on Long-Term Care that is expected to promise free nursing care for elderly people, wherever it is delivered, but not the wider free 'personal care' the commission called for;

a management academy and cash bonuses for 'the best-performing' hospitals, health authorities and GPs.

Mr Milburn told the NHS Confederation's annual conference in Glasgow last month that good health service managers would be given the freedom to work without political interference under a new 'traffic light' system.

But HSJ sources suggested this week that the general tone of the NHS plan will be 'anti-manager', with the 'escalating interventions' Mr Milburn promised for 'failing organisations' being turned into hard-hitting rhetoric for public consumption.

Last week's leaks of a report commissioned by Mr Milburn from Sir Richard Branson's Virgin group provide the perfect opportunity for the government to promise a 'crackdown' on 'incompetent managers'.

The report blamed 'squalid' conditions in NHS hospitals on 'stifling' bureaucracy and 'management by cascading paperwork'.

It prompted a furious response from NHS Confederation chief executive Stephen Thornton, who described it as 'superficial' and asked how many backroom staff Virgin needed 'to get one pilot in the air'.

NHS Confederation policy director Nigel Edwards said he believed the plan would be 'intolerant of poor practice, but not necessarily anti-management'.

He also said the plan would need 'a great deal of leadership at all levels'.

But David Hunter, professor of health policy at Durham University, said he had identified an anti-manager trend in government policy and added: 'I suspect the national plan will continue with that trend even more aggressively.'

See news focus, pages 11-13;

comment, page 17;

feature, page 31.

Flying kites and plugging leaks

March's Budget announced an average 6.1 per cent above-inflation increase in NHS funding for the next four years - linked to increased modernisation. Health secretary Alan Milburn then announced that a 'national plan for the NHS' would be developed, focused on five 'priorities' for the NHS identified by prime minister Tony Blair. These were eventually addressed by six 'modernisation action teams'. As work went on, a series of 'leaks' emerged. Highlights were:

May Early ideas include 'smart cards' for patient records and re-writing the Patient's Charter - a Labour election pledge.

June : The NHS Confederation captures headlines with its call to merge health and social services, an idea also apparently embraced by Mr Milburn; Mr Milburn floats the idea of cracking down on consultants'- including their private work - following the Rodney Ledward scandal; the government lets it be known that up to a third of the seats on the NHS modernisation board will go to patients.

July : At the NHS Confederation conference, Mr Milburn promises a 'traffic light' system to assess trust performance; the government is keen on the 'return of matron'.