'The NHS is about to embark on a journey to who knows where, armed only with the sketchiest of blueprints riddled with contradiction and ambiguity'

Alan Langlands clearly has his head screwed on. In a speech of no little savvy (See News Focus, pages 14-15), he warned managers last week against repeating the follies of the early 1990s when a 'couple of thousand' of them across the NHS seized control of implementing the internal market reforms, in the process isolating themselves and alienating most other healthcare professionals.

He showed, too, that he is aware of how unprepared much of the service is to enter into 'partnerships', citing an example from his own experience of the health authority chief executive and local social services director who had never met each other. And he knows others are elbowing out of the way potential rivals for power in the new order.

This willingness to acknowledge the realities is reassuring and in contrast to the centre's attitude in 1989-91, when the imperative was to deny the very existence of all obstacles and setbacks. Unfortunately, it doesn't go quite far enough. Worryingly, the parallels between Working for Patients and The New NHS are far too many for comfort. Mr Langlands was a little less convincing when he explained the NHS Executive's silence since the white paper's publication as a deliberate pause to let its messages 'sink in', then later blamed it partly on the distraction of the public health green paper. And the six key objectives he described as underpinning this grand strategy are as bland and obvious as anything dreamt up during the Major years.

The truth is that, as in 1989, the NHS is about to embark on a journey to who knows where, armed only with the sketchiest of blueprints riddled with contradiction and ambiguity. The main contrast today to 1989 is the fund of goodwill in the NHS towards the government. Whether that goodwill is deserved is another question. Its white paper may be redolent with assurances for a wide range of professional groups, but the destination to which it will deliver the service is as uncertain as the famous day of the smooth take-off with no surprises in 1991. In the words of Greater Glasgow public health director Harry Burns, the English white paper - unlike its Scottish counterpart - is a 'a dog's breakfast, a recipe for chaos'.

In their heart of hearts, most health professionals know this to be the case. In 1991 they protested vociferously; in 1998 they are silent. Is this due to a touching faith that, however it may turn out, it won't be as bad as the internal market? Or is it a sense that resistance is useless?