Have you lost the plot?; A three-part series that explains the issues behind the news

Is the NHS falling apart?
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The Independent Online
The plot: almost five years after the start of government reforms, the NHS remains in a state of near-permanent revolution, though managerial changes have largely worked through. Despite bitter debate, Labour has conceded that a divide will remain between health authorities that commission care and providers of that care. However, the role of GPs remains in dispute.

The struggle to keep the lid on costs continues. Stephen Dorrell, Secretary of State for Health, has launched a drive to cut bureaucracy created by the internal market. Better organisation and more day surgery have cut waiting times. But accident and emergency services are stretched and there is a shortage of intensive-care beds. The drive for private finance for new NHS hospitals has promised much but, so far, delivered little.

Prospects: rows will focus on health authorities' decisions about future eligibility for care for those with incurable conditions. Those who do not qualify will be discharged to means-tested care in private nursing homes, shrinking the NHS boundaries.

Then there is the thorny issue of how long-term nursing and residential care for an ageing population is to be funded. The Government is promising a White Paper and Labour, at present, a Royal Commission. Talks between GPs and the Government are likely to result in more treatment being transferred from hospitals to primary care.

Surrounding these changes is the debate about rationing and "evidence- based medicine" - providing treatments known to work. With that, some argue, the NHS can stay a tax-funded free-at-the-point-of-use service. Others maintain that medical advances and an ageing population will result in a "core NHS" with new charges and other direct payments. Neither the Conservatives nor Labour are keen to engage in that debate directly.

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