Tony Blair once remarked that Labour's record spending increases and reform were the last chance for the National Health Service. If they did not work, the prime minister warned, waiting in the wings were politicians who would dismantle the NHS. The reality is somewhat different. There is no ideological difference between Labour and Conservative. The real difference, in Rumsfeld-speak, is that Labour ministers know what they don't know while the Conservatives don't know what they don't know.
While the opposition is in the foothills of a policy review, ministers are grappling with the toughest challenge in public sector management: how to transform the NHS from a relatively simple but obsolete supply-constrained model to a patient-driven, demand-led one. Conceptually their vision is right; but the design capability and implementation plan to realise this vision have been missing. The Department of Health began implementing a partially designed system, leaving the rest to be worked up as it went along.
