COMMENT: Health policy on chaotic course as U-turns and re-thinks proliferate

The latest NHS reform bill is due to be put before Parliament just as U-turns in domestic policy are becoming something of a habit. Like cannabis, food vouchers and student grants, it seems that health policy is not immune from diversions in the course that has been set.

The fundamental principles on which health secretary Alan Milburn set about building second-term health policy seem to be unravelling. It looks as if community health councils, expected to face an imminent demise, will be around for a little longer, while patients' councils - umbrella bodies of patient forums - originally accepted as an amendment to the Health and Social Care Bill, appear to have been revived.

More significant, perhaps, is the emerging role of the Commission for Health Improvement. Until now the government has been at pains to maintain that CHI is not - and would not become - an inspectorate in the Ofsted mould. Yet it is hard to see the difference between the education watchdog and what is being proposed for health.

It would be foolish not to put the vast quantity of information that the commission is collecting during its clinical governance reviews to good use. But the concept of placing trusts that are not performing well on special measures is at odds with CHI's role as first mooted. The NHS can only hope that the policy-makers have learned from the controversies and mistakes in the education sector before they begin work on the revised version of CHI.

The reform bill will include the legislative changes necessary to make Shifting the Balance of Power a reality. It could be argued that setting up the new organisations before Parliament has had its say is presumptuous - even risky. But in contradiction of the bill's avowed intent, there are few signs of a genuine desire to allow frontline staff to become decision-makers. Mr Milburn has even determined the membership of the local cleaning inspection teams, rather than letting individual trusts decide for themselves.

And just as progress begins to be made after months of negotiations - and not a few hiccups - in trying to agree pilot schemes for private finance initiative hospitals, Mr Milburn heads off to Spain in search of inspiration on different ways to approach the issue.

He purports to be completely opposed to the idea of re-introducing the internal market in health - 'complete bollocks' he told HSJ - but is exploring ways of allowing patients to decide where they are treated in a health economy based on 'contestability'.

All in all, it seems that the Department of Health is not quite sure where health policy is going and is allowing the need for positive tabloid headlines to dictate every new knee-jerk reaction or initiative re-announcement.

While the DoH is adamant that the plan and its targets are still at the heart of everything that is going on, there seems to be little else of which we can be certain. l