The health service has been told not to expect any 'courageous' moves from the new government before the general election.

Speaking at a conference on commissioning this week, King's Fund chief executive Niall Dickson said prime minister Gordon Brown was a 'one-bullet gun', who had to win a general election within two years to stay in power.

'Being courageous is not an option for the government. I expect from May next year the race will be on and that will affect the way health policy will go.'

Health secretary Alan Johnson's priorities of MRSA, the 18-week target, access and clinical engagement were in line with King's Fund's expectations.

The 'relationship between health and social care was not an issue to win elections', Mr Dickson said.

He also revealed that on a visit to the King's Fund just before Mr Brown became prime minister, he cited Treasury adviser Sir Derek Wanless's work on social care as the most important thing he had learned about.

Mr Dickson said: 'I think we have changed the government's mind on social care. If it comes out with zero per cent for social care in the comprehensive spending review they will not have any credibility at all.'

Mr Brown's 'fondness for means testing as a device to tackle poverty' could clash with Mr Wanless's work on social care, which recommended that it should not be means tested. Mr Dickson said it would be interesting to see how the government developed its plans.

Speaking at the same event, shadow health secretary Andrew Lansley criticised the decision to commission health minister Professor Sir Ara Darzi to carry out a review of the NHS.

'He [Alan Johnson] has started by saying that he wants to review until next year. It's crackers, things are happening out there, things need to be done in a consistent framework.'

  • This week the King's Fund formally launched its report Windmill 2007: the future of healthcare reforms in England, based on a simulation of the health system in partnership with forecasting specialists Loop2, Monitor and Nuffield Hospitals, previewed in HSJ earlier this month (see opinion, pages 18-19, 5 July). Speaking at the event, Monitor chair Bill Moyes said he expected changes to be felt much more at the level of individual services than institutions in future. 'Effective commissioning will indeed generate very real risks for providers but those risks will be about individual services or groups of services,' he said.