Leading article: The next test bed for health reform

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An "unholy mess" is how a joint editorial in the British Medical Journal, the Health Service Journal and the Nursing Times describes the effects of the Government's reforms of the NHS this week. It is just the latest salvo from the medical establishment in a campaign that has reached fever pitch. So fiercely are different vested interests resisting the changes, however – which are predicated on patient-centred GP commissioning of services – that campaigners may have allowed their attention to be diverted from a development that could alter health provision at least as radically as anything envisaged in the contentious Health and Social Care Bill.

Yesterday, Circle became the first private company to take over the running of an NHS hospital – Hinchingbrooke in Cambridgeshire. Circle already runs a hospital in Bath and several clinics, but this is the first time a privately run hospital will take its place in the NHS. The chief executive says he wants to turn a "basket case" into one of the top 10 hospitals in the land.

Whether Circle succeeds or fails, this is an experiment that will be watched with more trepidation by NHS staff, and more enthusiasm by ministers, than either side has so far admitted. For NHS staff, the transfer has been hard to oppose, because their pay and conditions have been maintained, and the alternative to private management could have been closure. For their part, ministers may have fought shy of saying too much in public for fear of unleashing a new round of charges that the Government is trying to privatise the NHS by stealth.

The relative quiet that has surrounded the changeover at Hinchingbrooke, though, should not disguise how much is at stake. Success would not only open the way for more private companies to take over the running of hospitals, but also help to demonstrate that at least some of the NHS's problems can be blamed on inadequate management. If, on the other hand, improvement at Hinchingbrooke, either in terms of care quality or cost, is not achieved, trade unions and others will hail this as showing the limits of what the private sector can achieve. It is hard to overstate how much now rests on Circle's shoulders.

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