The NHS in England is to undergo a major restructuring in one of the biggest shake-ups in its history. GPs will form new consortia and assume responsibility for spending much of the NHS budget, hospitals are to be encouraged to move outside the NHS to become a 'vibrant' industry of social enterprises, patients will receive more information and choice, and all ten strategic health authorities and 152 primary care trusts will be abolished.

Many will welcome the transfer to authority from managers and politicians to frontline healthcare professionals, which is consistent with the Government's 'Big Society' commitment to strengthening communities, while others will question the risks involved in such radical reform. I thought it worth revisiting the Jubilee Centre's 2002 report Health and the Nation. A section headed Expectations: Consumerism and Covenant noted:

True health is difficult to recognise, difficult to realise and impossible to buy. Moreover, it involves rather more than a one-off transaction, demanding the 'consumer's' long-term, full-time and high intensity commitment just as much as it does the 'provider's' efficient and professional use of resources.

An open admission that public healthcare cannot achieve the consumerist utopia of unimpeachable immediacy, convenience and quality is a preliminary necessity (as is the need to weather the predictable lambasting for 'willingness to accept second best' that such admissions provoke). An ensuing recognition that obligation is a two-way process which demands trust and commitment from both parties also acts as an antidote to the immensely destructive "everything, now" ethos of unbridled consumerism that threatens to pressurise further the NHS.

The booklet concluded by identifying a number of areas where evidence needs to be carefully examined that remain relevant to these latest proposals:

• Is the principle driven by a verifiable knowledge or a vague belief that patients will receive better treatment?
• Is it driven by a recognition that localisation provides better patient care or by a silent desire to absolve central government of responsibilities?
• Does it treat the symptoms of an ailing service rather than its causes?

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