How many health service managers and policy-makers believe the NHS plan targets will still be achieved? Are there any, other than those in Richmond House whose job as cheerleaders is to swear - however contradictory the evidence - that everything is on track?
Fifteen months after the plan's launch, the initial euphoria it prompted has long since dissipated. In its place, doubt and pessimism have seeped in. Each week seems to bring fresh confirmation that reality is drifting ever further from the blueprint which was heralded as the service's last chance. Ministers' response is to add yet another panicky new initiative and search for somewhere to place the blame (see below).
Last week's blow was the Audit Commission's report on waiting times in accident and emergency departments - longer now than when the plan was published, longer even than when Labour took power almost five years ago. Patients and public already needed a lot of convincing that the NHS was improving; they will need twice as much now. For the trolley wait has become a loathed and potent symbol of the health service's failings. The irony is that the prime minister himself first made it so in a 1996 speech while still in opposition (see pages 1213).
Last week's initiative in response to the commission's report was health secretary Alan Milburn's promise in his Fabian Society speech to offer patients a choice of hospital. This announcement sends a raft of new problems sailing towards those currently struggling to manage the service on the front line. As any of them will tell you, one of the most frustrating tasks they face is coping with the consequences of patients' expectations prematurely raised by the NHS plan. They need time to get to grips with reorganising services to meet these demands before more are added, otherwise they risk failing on twice as many fronts.
Then comes the challenge of devising a payments system to ensure that providers are promptly and adequately funded for treating patients who choose hospitals other than their local one. What price slashing bureaucracy now?
But the eeriest aspect of this announcement is its echo of the past: the rhetoric of 'choice' was the constant refrain of Conservative politicians peddling the internal market a decade ago. It singularly failed to widen patient choice. Mr Milburn may deny it, but his proposal stops not far short of reintroducing the internal market whose abolition Labour loudly trumpeted on taking office. When that happened - mindful that in health policy, what goes around comes around - HSJwarned that it was only a matter of time before someone, somewhere touted its return as a solution to the NHS's ills. Little did we think it would be a Labour government; little did we think it would be Mr Milburn; little did we think it would be a mere four years after its disappearance. l