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Andy Jones: Where is reform taking us?

Reform of the NHS is set to enter a new phase in 2006. It is no secret that the NHS faces huge financial pressures in 2006 despite record levels of funding.

Reform of the NHS is set to enter a new phase in 2006. It is no secret that the NHS faces huge financial pressures in 2006 despite record levels of funding.

Service cuts and constraints have been widely reported. So where are the reformers taking us?The mysterious world of political advisers has seen a change of personnel. Until late November last year, Tony Blair's adviser on health policy was Ian Dodge. He is a civil servant known for having sprung some pretty off-the-wall ideas on the NHS.

I understand he has been moved sideways to a desk half a mile away in Richmond House ­ a desk slightly less accessible to the PM.Another adviser whose name keeps cropping up is Matthew Swindells, who was appointed to advise Patricia Hewitt last year. I thought it might be interesting to see what he was up to, but got a complete zero by typing his name into the Department of Health website or contacting the press office as to policy publications.Insiders point to the Labour backbench unrest at the future White Paper on health, which is clearly the reason behind shuffling advisors. So step forward Paul Corrigan, new prime ministerial appointee.

I'm not sure that he could start a row on a desert island by himself, but it has been suggested that he would be well-equipped. His first pamphlet, 'Size Matters', has argued that the small business model of general practice is not fit for purpose.GPs are referred to as 'the 9,000 independent traders that have served the country well'. Note the past tense!

Whether we head up HMOs, work for private companies, form mutual trusts or are forced into giant partnerships is yet to be seen. Many recent NHS changes have been introduced without legislation. Alan Maynard, health economist at the University of York, has commented that some of the changes are 'an evidence-free social experiment'.

Going back to Ian Dodge, recent copy in the press has suggested that no one in the department appears to have a 'full grasp' of the complexity of the Government's health reforms and that one of the reasons for his move is that he will be able to explain all. Some might say 'any grasp at all' might be a better phrase to use than 'full grasp'.

What I think would be beyond question is that patients don't care who is advising whom, or what degree of 'grasp' is being exercised ­ they just want decent health care and feel there has been precious little reform of late.

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