What a surprise. The government has started the grand consultation that will lead to the production of a 'national plan for health' by swearing those involved to secrecy.
The members of the modernisation action teams that met for the first time last week were left in no doubt about the perils of speaking out. One manager managed to tell an HSJ reporter it had all been 'very inspiring' - but that was off the record.
It is, of course, ironic that the meetings were marked by a Department of Health press release claiming that 'a million staff ' would be given a chance to shape the future of the NHS. It is even more ironic that they more or less coincided with the publication of a book by commentator Will Hutton pointing out (again) that there is a sizeable democratic deficit in the NHS.
Mr Hutton's book calls for the NHS to be given its own constitution to keep politicians from interfering with its founding principles, and for it to be set up as an independent institution - even an elected body. A constitution is an interesting idea: although there would surely be a temptation for incoming politicians to rewrite it, or get around it. But the idea that the NHS should be taken out of politics comes around with the changing of the seasons.
Mr Hutton is not suggesting, anyway, that politicians should be kept out of policy-making or allocating funds - the key drivers for the direction of the NHS.
What he wants is public involvement in the constitution, believing this will bolster support for the NHS and trigger a 'mature debate' on issues such as rationing, a more open policy-making process and acceptance that the centre cannot implement policy locally.
It is difficult to argue with either of the last points, put that way. Unfortunately, the current round of policy-making is not only opaque, but looks perilously like a process for quashing dissent. Almost every group that might disagree with the government's ideas is now locked into its working parties - and suddenly they have all gone very quiet. The process also adds to the impression that ministers would like to micro-manage the health service from Whitehall.
None of this is likely to change, however, when the spats exchanged by the two main political parties this week suggest we are already in the opening stages of a long drawn-out but less than edifying election campaign.
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