Comment: Endless administrative upheaval may have jeopardised essential reform

Published: 28/02/2002, Volume II2, No. 5794 Page 19

Health secretary Alan Milburn summoned 500 trust chairs to a conference in London last week to tell them that he planned to abolish primary care trusts. Not really - that was his little joke. But many a true word is, of course, spoken in jest.

And while PCT abolition is probably a good few years away yet (what are the odds they will make it to the end of the decade - evens? ) Mr Milburn's quip astutely captured the spirit of the times: NHS organisations are dreamt up, launched, merged then axed at an ever dizzying pace, mainly on the whim of ministers. But at least Mr Milburn was frank that the latest unwanted upheaval presented 'huge risks' across the service.

Some might think that admission rather rich, especially as he dropped no hints that he had worked out any contingency plan in the event of these risks coming to pass once the 'piece of the architecture' has been removed to reveal the new structure.

And who exactly will be bearing the brunt of the risks? Mr Milburn himself?

Possibly: anxiety about the state of the NHS is running so high among the public that any significant disaster might well claim his political career. The hapless managers struggling simultaneously to implement this reorganisation and the rest of the modernisation agenda? Probably: scapegoating is now an established part of the politico-managerial interface. The patients? Definitely: every effort spent on restructuring means less effort goes into improving the frontline patient experience.

While the NHS plan will indeed be judged - as Mr Milburn claimed - over its 10-year timescale, it will also be judged at regular and much shorter intervals all the way up to 2010 and beyond. Its biggest test will come around 2005, at the time of the next general election. A great deal must change before then if it - and the government - is to pass that test. Ministers may still come to rue indulging in the distraction of Shifting the Balance if rather more basic features of NHS care than its administrative shape have not altered beyond recognition by then.