COMMENT: New Labour's NHS reform so far is mostly spin and cosmetic change

It has well and truly begun: the prime minister has yet to fire the official starting pistol, but the general election campaign is to all intents and purposes already under way, with the Conservatives and Liberal Democrats choosing to launch their offensives with major health policy statements in the last week.

But Labour's record during the past four years will be the main focus of attention in the health policy debate - which pundits have quickly identified as one of the main election battlegrounds. We begin our own election coverage with a 'vox pop' report on what the man and woman on the Clapham omnibus think of the government's NHS reforms. It is interesting to compare their assessments with those from a very different quarter, coincidentally published this week: the King's Fund poses the awkward question, 'What has Labour done for primary care?' and answers it as bluntly as passengers on the top deck of the 159 from Marble Arch - if with rather more academic rigour.

The fund's verdict is that Labour has so far failed to achieve any fundamental shift in the balance of power from acute to primary care or from the professional to the patient.

Its vision may be praiseworthy but it has been marred by overblown rhetoric. Primary care initiatives such as NHS Direct and walk-in centres are fine, but most NHS resources remain steadily targeted at acute care. Labour's strategy for dentistry will soon be proved woefully inadequate - a personal embarrassment for the prime minister - while the public remain as obdurately excluded as ever from decisionmaking about both their treatment and local service provision. What is more, the proposed mechanisms for public involvement after the abolition of community health councils have been exposed as ill thought through, and Labour's curious blend of populism and central control is, in the fund's opinion, unlikely to foster it.

All spin and cosmetic change is pretty much the consensus on the Clapham omnibus too. Its passengers profess not to be rattled by recent NHS scandals - Bristol, Alder Hey, Shipman and Ledward - as much as they are irked by the service's longstanding problems of waiting lists, staff shortages and perceived underfunding. According to 65 per cent of them, the NHS is either the same or worse under Labour than the Tories, while a quarter claim they or their family have had a recent bad experience of it. Of course, none of this is remotely scientific, but to a party famous for paying close heed to focus groups it ought to give pause for thought. Comfort for ministers may lie in expressions of understanding that change takes time and acknowledgements of good NHS experiences. And so far the polls suggest the Tories' health policies have failed to excite the public's imagination. Let's hope that does not make Labour complacent about the NHS.