Though the NHS plan remains a focal point, nagging questions remain

Published: 11/07/2001, Volume II2, No.5813 Page 17

In July 2000, HSJ greeted the NHS plan as 'a grand utopian vision deserving of success' and resolved to 'travel hopefully' towards the promised land depicted in the 144-page document. Two years on, we see little reason to change our view. The plan's ambitions are still the flag around which the NHS should rally. But we also asked, 'where will the extra staff come from? How will those already in place manage this colossal new agenda on top of existing workloads?' Have the last 24 months answered these questions? Despite the Budget's funding boost, the reply must be 'not really'.

This week, Professor Joan Higgins (cover feature, pages 24-29) writes: 'It is remarkable that a wide spectrum of opinion still believe it is the right plan, with the right vision for the future. Any complaints have been about the pace and style of implementation, rather than matters of substance.' She is correct, and in HSJ's leader of 27 July 2000, we praised the plan for being 'redolent of close-up contact with the service'. But in the wake of proposals for foundation trusts, overseas clinical teams and an unpopular settlement on the consultants contract, we have to conclude that the government appears to have let the closeness of that contact slip.

The NHS plan endures. Those who were sceptical about it in 2000 remain so - and for the same reasons: that the political will is likely to fail in the face of short-term pressures; that the plan is simply too ambitious; or that the NHS is an outmoded idea.

The plan's supporters point out that its goals (shorter waiting times, more beds, more staff, more money, a primary care focus, and so on) are exactly those that would come to mind if you sat down to write a new plan today.

So what have the first two years taught us? That this government is committed to delivering the NHS plan; that the methods of delivery are not necessarily those envisaged back in 2000; that the service is largely succeeding in meeting the targets; and that uncertainty over whether it can achieve the necessary step-change over the course of the plan's remaining eight years remains undiluted. Despite the constant background white noise of an 'NHS crisis' from the national media, this is where We are at.

To draw a parallel with the World Cup, the NHS has battled its way through the first round and is looking forward with reasonable optimism to the next contest. But reference to the NHS plan wallchart indicates tougher battles ahead.