PATRICIA HEWITT, the Health Secretary, admitted yesterday that the NHS “no longer knows where it is going”.

“Where will we be in five years, ten years, fifteen years’ time?” she asked. She gave no answer, other than it lay in the hands of local NHS organisations — and the Government’s reforms were designed to empower them to discover it.

In a speech peppered with such admissions, Ms Hewitt said that it was hard for anyone to understand that after years of unprecedented investment, the service was dealing with financial problems.

“After years of more staff, there are now job losses,” she acknowledged — a fact she has hithero denied by arguing that posts, and not jobs, were being lost. But she went insisted that reforms were the way to sustain the values of the NHS and that the Government would not undermine those values.

“The changes and reforms we are making are not only compatible with our traditional values: they are essential if we are to protect those values in a fast-changing world,” she told an audience in London.

Speaking to the Institute for Public Policy Research, Ms Hewitt said that the NHS was “a 1940s system operating in a 21st century world”, and where patient care was improving it was despite the system, not because of it. Calling for an end to the old “top-down” system, Ms Hewitt emphasised the need for strong local commissioning of services, underpinned by national standards and targets. On the issue of private service providers, she said: “If independent providers can help the NHS provide even better care and value for patients, we should use them.”

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