Simon Jones on the future of the health service in Wales

The second was a party to celebrate the 60th anniversary of the NHS and the 50th anniversary of Paul Robeson and Aneurin Bevan's address to the National Eisteddfod in Ebbw Vale, Bevan's home turf.

We do looking back very well in Wales. The true test of the health service reforms that are about to take place will be whether we do looking forward well also.

Changing times

The reforms, as we now know they will be, are much as previously trailed in this column. Built on the principle of getting rid of the internal market completely, there will from some point in 2009 be only one NHS tier beneath the government.

This is very similar to the current Scottish model. At the centre there will be some form of national board, which the health minister has indicated she will ponder on through the summer. She also said there should be a much clearer and greater scrutiny role for community health councils in Wales.

And she made another very interesting comment that I will return to in a while.

We will now have a further round of, one assumes, much more detailed consultation starting sometime in September. In the meantime, while the health minister ponders, the civil service must beaver.

Reorganisation is always far more complex that it at first appears. Suddenly, issues appear that need sorting out in respect of staff, contractual relationships, service relationships, finances and so on.

In post devolution Britain, the process is made more complex by having to unpick which powers the health minister has and what needs to go through Westminster.

Battle lines

It is relatively easy to predict where divergent views and, indeed, the odd battle line will arise. The civil service and the NHS will differ on the nature of the national board, and primary care will be keen to see that their services receive the proper attention (quite rightly) in the new system.

There will be lots of input into the consultation on the governance of the new integrated organisations. I would be amazed if local government did not argue strongly that locally elected councillors should be involved. The NHS will, I am sure, make a strong case for small boards able to focus on corporate and clinical governance issues. Others may well make a case for much larger "stakeholder" boards. All this will have to played out in the context of Wales' very strong and commendable policy of making public services more citizen focused and ensuring citizens are at the heart of strategy development, service development and scrutiny.

And while all this is going on, the eye must not come off the ball - the day job remains. We have very challenging targets to be achieved by the end of this year and then again in December 2009. We have an increasingly difficult financial environment in which to work and as tax revenues get tighter in the current economic climate, there is little to no prospect of any significant real-terms growth to cope with rising demand and shorter access time targets. A perfect storm.

This is no doubt the time for non-executives to step up to the plate, to make sure their executives and their organisation get on with the day job while at the same time keeping an eye on what needs to be achieved to ensure a smooth transition from one system to another.

Built to last

Before I forget, the other interesting statement our health minister made was that she hoped to create a structure that would last for the next 20-30 years. I first became involved in health boards of one type or another nearly 20 years ago and I tried to add up the reorganisations I have experienced. It is either four or five. Sometimes it is difficult to work out what exactly constitutes a reorganisation!

And given the coincidence of the celebration of Bevan's achievement and the announcement of the changes to the health service in Wales, my thoughts inevitably strayed to Bevan's views on change.

He said: "The NHS must always grow and change, it must always appear inadequate."