How stands the health service as we reach this, the last issue of HSJ in the 20th century?
Underfunded, under pressure and under-appreciated. The NHS is caught in an ever more bizarre cycle in which the same old problems rise to prominence accompanied by the same siren voices chancing the same illusory solutions.
And so the last month of the decade has seen the service catapulted back to the late 1980s, with forecasts of looming financial crises prompting calls for a 'root and branch' review of how the NHS is funded - in the face of the government's refusal to entertain any such notion. Back in 1987, the then Institute of Health Services Management took the initiative in opening this debate; in doing so it helped pave the way for the internal market. Today, the British Medical Association is taking the lead. Those who ignore the lessons of history are doomed to repeat its mistakes.
Meanwhile, as an inadvertent complement to the BMA's initiative, the right-leaning national newspapers are running campaigns to highlight the NHS's shortcomings: elderly people are left to die because money is short, cancer patients must endure treatment on a par with that provided in the developing world, heart patients are dying on waiting lists before they can undergo operations which would save them.
Whatever the truth behind the allegations - and undoubtedly some of it is a scandal of which the service should be ashamed - the irresponsible message is unmistakable: it is time to sweep away a publicly funded health service, free at the point of use, and replace it with a fee-paying insurance based system for the many and a safety net for the unfortunate minority.
Few of the hacks churning out their instant solutions have much grasp of health policy or the implications of what they suggest. They select and marshal facts to fit preconceived theories.
Unlike the 1980s, however, the government today is more likely to raid the exchequer than to be tempted by any 'radical' alternative to paying for healthcare. But for how long? And can the NHS rely indefinitely on the store of goodwill which in the 1980s ensured public hostility to any hint that the Conservatives might fundamentally alter funding principles? It may find that Thatcher's children, as they reach maturity, are far less tolerant of the NHS's lack of the slick consumerist touch. Modernise or perish is the unspoken message of the current reforms.
Preoccupation with reforms has been the lot of the NHS manager at the end of the 1970s, the 1980s and now the 1990s. In December 1979, the then social services secretary, Patrick Jenkin, launched his consultative paper, Patients First. It proposed abolishing area health authorities and increasing the power of the hospital administrator, with the twin aims of bringing HAs closer to staff and speeding up decision-making. They were gentler, more innocent times. Writing in HSJ, Mr Jenkin pledged to 'try to strike the right balance between the need for change and the need for stability', while disruption would be 'kept to a minimum'. With disarming honesty he admitted: 'There is not as much cash as we would like' in the NHS.
Ten years ago, managers were wrestling with Working for Patients, published in January of that year which also saw waiting lists rise to a new and embarrassing peak, public concern about the levels of support for mentally ill people moved from long-stay care into the community, and much discussion of an impending information technology revolution in the NHS. Plus ca change. . .
And at the end of 2009? Will The New NHS be a yellowing historical document by then, its once promising avenues having proved blind alleys? Or will it be seen as having rescued the NHS in the nick of time, ensuring its longevity well into the 21st century? Prime minister Tony Blair has said, after all, that it is a 10-year programme. Few governments get the chance to see through 10-year programmes, and probably most are privately relieved that they do not. But, to take a lesson from the past, the only sure prediction to make about the future is that it will look nothing like anyone's prediction.