Proposals to abolish the internal market, end the purchaser provider split and fund services from the centre are setting Wales' health service on a different course from the rest of the UK.

The coalition government is billing the changes as part of its drive to encourage co-operation rather than competition in public services. The proposals, which will see local health boards reduced from 22 to eight, will certainly require good relationships between organisations and individuals - often across vast tracts of land.

The boards, which until now have been commissioners, will have a transformed role, becoming providers of community services and responsible for service planning largely via the information they feed back to the proposed national health board.

The consultation contains a number of rather open-ended questions about the make-up and role of the local and national boards, leaving the precise shape of the Welsh NHS to be determined.

Upon launching the consultation three weeks ago, Welsh health minister Edwina Hart said she looked forward to "12 weeks of vigorous debate". Sadly for Welsh health professionals and interested observers elsewhere, organisations representing both managers and clinicians seem reluctant to get off the fence and voice their opinions, despite whispered warnings that the changes will give the health minister a great deal of control over service provision.