Two issues highlighted in HSJrecently - the model contract( HSJ, page 5, 1 February 2007) and an NHS charter( HSJ, opinion, pages 18-19, 2007) - show how current NHS reform is engendering contradictory expectations.
Mark Britnell eulogises the 'legal power and autonomy' of foundation trusts as a blueprint for 'pragmatic' depoliticization of the NHS. On the former, we see that patient choice - and local freedom to manage - is subverted by central diktat: driven by the deficit crisis, commissioners do not have to pay for hospital treatment which they have not authorised, amid howls of anguish from the Foundation Trust Network.
What ministers still can't (or won't) absorb is that many acute trust deficits are actually bad debt: where primary care trusts can't (or won't) plan alternatives to hospital, they can't afford to pay the hospitals for 'excessive' but necessary care. The political decision this year, in reaction to last year's deficits, is to attack the symptom rather than the cause, ie 'forbid' payments that can't be afforded.
If patients are referred to hospital outside the 'new model contract', then tough. Thus New Labour's new market metamorphoses into the Old Tories' internal market - rightly derided by the late Robin Cook (when shadow health secretary) as 'the patient follows the money'.
Any 'NHS charter', against the background of such political imperatives, would resemble what Alan Milburn's baby, foundation trusts, require after their savaging by prime minister-in-waiting Gordon Brown - powder and puff.
A depoliticized NHS is what Western civilisation was to Gandhi - 'a nice idea, but it'll never happen'.
Calum Paton is director, Centre for Health Planning and Management, and professor of health policy, Keele University.