Published: 26/05/2005, Volume II5, No. 5957 Page 22

John Lister, information director, London Health Emergency

Former health secretary John Reid inherited a relentless 'modernising' agenda from his predecessor Alan Milburn and showed little concern for the consequences. So the arrival of Patricia Hewitt and a new, more challenging parliamentary situation may offer room for more mature consideration.

More thought is urgently needed before forcing through policies that will prove devastating for many trusts and prove more controversial than the establishment of foundation trusts.

Bradford aside, few local people will have detected much change after the launch of the first wave of foundations: but they will soon notice the closure of well-loved units and hospitals if payment by results is implemented next April.

The 'reform' package that has taken shape represents a massive leap in the dark for the NHS, with no evidence that it can work as the modernisers hope.

The combination of payment by results and the implications of pressing home the diversion of 10 per cent of elective work to private providers threatens to destabilise trusts.

And in many areas the same policies will also undermine any genuine 'patient choice': the new quota will mean primary care trusts will be obliged to dispatch patients to private hospitals they have not chosen, while popular local NHS hospitals are forced to close departments which run above reference cost or fail to fill their beds.

Among the biggest losers under payment by results will be the first private finance initiative-funded hospitals, which have too few beds and therefore lack the capacity to treat additional patients, but carry inflated, inflexible unitary charges to the PFI consortium.

Perhaps this will help focus Ms Hewitt on the need to rethink these planks of New Labour policy before the whole system lurches from cuts this summer into crisis next spring.

It would be good if she were brave enough to ask patients what they really think - or even offer them a real choice.