The way forward for health?

Unveiling a "new vision" is a tricky business at the best of times. When it involves changes to the health service, tricky just doesn't cover it.

There's the question of how 'new' it truly is, how much of a 'vision' as opposed to a half decent, practical plan, how likely it is to be turned into reality - oh, and yes, it won't mean my local hospital closing, will it? Just you wait to hear what the opposition parties have to say about that.

Mind you anything 'visionary', according to their AMs, is distinctly lacking around Cardiff Bay these days.

At their briefing this morning Plaid Cymru seemed prepared to admit that the Education Minister, Leighton Andrews, "appears to be" getting on with job of thinking hard and thinking big about changes to the Welsh education system.

The Local Government Minister, Carl Sergeant, got an honourable mention too "but they are exceptions."

The translator had his work cut out. Alun Ffred Jones banged the table as he spelled out just how gobsmacked he is with what he regards as Labour inaction on boosting the Welsh economy. He could only "rhyfeddu" - be amazed. "Labour is a party elected on a pledge to stand up for Wales. I don't get it. What are they doing??" The second question mark is mine. The frustration with the Labour government his. "Let it prove that it is NOT adrift".

The Liberal Democrats raised the issue of European funding. How is it, they asked, that while 59 of the 66 European regions who received EU cash are now relatively better off, Wales' relative GDP has declined? "It is a damning verdict on the Welsh Government's economic competence".

For the Conservatives Andrew R T Davies took up the cudgels over health.

Six months after the election "where is the Labour vision? I can't think of an incoming government anywhere, on an issue that takes up 40% of its budget, that would not ... have come forward with a clear route map on delivering the policies they fought the election on."

You sense a theme developing. In May Labour did what they do very well in Wales - they held on to power. What are they doing with it?

The Health Minister is just getting to her feet to spell out what she intends to do with her bit of it. She'll unveil not just a "route map" but a "new 5 year vision" that will tell us what the health service in Wales will look like in future.

You can read the document, Together for Health, as a whole here.

If you do, you may well spot commitments that don't sound that 'new'. Delivering care closer to home? District general hospitals to stay open but to evolve while specialist services are centralised in centres of excellence? Concentrating on prevention rather than the expensive business of curing?

You'd be hard pressed to find anyone with an interest in healthcare who'd regard any of those ideas as 'new'. Anyone who read Designed for Life published back in 2005 could probably quote them back at you.

At a briefing this morning the Health Minister seemed prepared to concede as much. Yes, said Lesley Griffiths, this is a continuation of Labour's thinking on the best way forward for healthcare but "today we're just taking it that bit further". "The newness" added David Sissling, the Chief Executive of NHS Wales "is in the way it is put together. It is more than the sum of its parts".

What that means, I think, is this: with fewer, larger Local Health Boards the government thinks its chances of delivering these changes, this time, are much, much better. It is also clear to everyone involved that there is no money to spare so, frankly, what is given from the top will just have to be made to work locally.

There will be new targets and a new onus on Health Boards to publish performance records.

Policy and direction will come from the top. Delivery will be bottom up. I lost count of the words used to hammer that one home. There was "rapid translation" to local delivery, "a rapid switch" to local delivery - only that will allow the government to deliver a world-class health service - that was the vision of Dr Chris Jones, medical Director of the NHS.

What is truly 'new', perhaps, is the urgency with which it's being presented. The vision might not be entirely new but this time? We mean it.