comment: Cyclical reform is all very well - but watch out for that back wheel coming off

In the manner of Sir Humphrey , a former senior civil service this week tells HSJ readers that policy-makers 'are in danger of disappearing up their own fundament' (news focus, pages 911).

That cyclical reform has become part and parcel of working in the NHS might almost be amusing if it wasn't for the fact that it makes managers, staff and patients so weary - and wary - of change. For many of these structural upheavals, there is little in the way of an evidence base - apart from the fact that it probably didn't work particularly well the last time something similar was tried.

The problems of the NHS in 2001 are the the perennial ones, the ones it had at the beginning - not enough staff, not enough beds, not enough money. And whatever the political hue of the administration, the solutions are not that different, either. But every government has to make its mark, and introducing competition, shifting power to primary care, and changing the number of health authorities is as good a way as any.

It worked for Margaret Thatcher for three terms. Tony Blair must be hoping it is just as successful for him.