Target slippage means some of its key ambitions are unlikely to be achieved

Published: 21/03/2002, Volume II2, No. 5797 Page 17

Time waits for no-one, not even government ministers. The NHS plan will soon be two years old, a fifth of the way along its intended trajectory. Now some of its stated ambitions are beginning to look unlikely to be fulfilled, at least within the original timescale.

For example, take the independent reconfiguration panel outlined in the plan as a means of quelling local aggravation when old, much loved institutions face closure - usually involving loss of an accident and emergency department - and replacement often by a combination of smaller facilities near the same spot and a more modern hospital some distance off. No doubt ministers looked forward to the panel deflecting some of the heat and ire which 'save our hospital' campaigns generate and funnel at them.

But the panel so far consists of a solitary chair, and has yet to start work. Meanwhile, a queue is forming of proposals for major service changes, each highly controversial in its locality and all with potential to be politically explosive.

A government which in the general election lost a minister's seat to a consultant who won a 17,000 majority by fighting under the banner of saving his hospital will need no reminding that it has to handle such cases delicately.

No matter how adroitly advanced the arguments for reconfiguring old and failing facilities, the public mood of scepticism in the face of 'expert' opinion tends to provoke implacable resistance.

To make things worse, ministers appear to be tripping over their own feet in their evident anxiety to improve on this area of policy. For the reconfiguration panel was not the only related measure in that capacious portmanteau of reform, the NHS plan.

Local authority scrutiny committees were assigned a role too - and now some of them are about ready to begin exercising it.

The problem is that it is not at all clear how to reconcile their part with the panel's - or indeed with that of the ultimate buck-stopper, the secretary of state. To add to the confusion, some policy analysts suggest that reconfiguration has had its day anyway, and an alternative approach is needed.

Ministers look panicky about the plan's progress towards its deadlines. John Hutton this week announced that he is to 'take the brakes off ' the private finance initiative, rolling it out despite the pilot sites' unfinished business. He wants to cut the costs and time involved in procurement. 'The most important time involved is the time - any time - that the public have without their new hospitals.'

True, but his decision has left neither industry nor unions happy - not the best prospect for making so complex and controversial a policy successful. Politicians may constantly hear time's winged chariot drawing near. That, unfortunately, may not always be the best frame of mind in which to make far-reaching decisions.