A DECADE ago, I wrote to suggest the NHS was entering a new age, in fact, a brave new world. Today, I would like to qualify it, raise the stakes a little higher.

It is about to enter a very, very, very brave new world indeed.

And to those who would prefer not to know, I would say, before you bury your heads in the sand, please test the temperature as it can be scorching, even for a hardened ostrich!

There are 28 strategic health authorities in England that are going to become autonomous.

The largest in area size are Cumbria and Lancashire; North and East Yorkshire and Northern Lincolnshire; Trent; Norfolk Suffolk and Cambridgeshire; Avon, Gloucestershire and Wiltshire and South West Peninsula.

These are not necessarily in any order of size.

The point to be made here is that the most attractive authority to the investor will be London which is neither here nor there according to area size and also the richest.

The Government is intent on finding new sources of funding for healthcare, including user charges and voluntary insurance (Prof Allyson Pollock).

Commissioning of NHS healthcare will be undertaken by private companies such as BUPA, United Health, Kaiser Permanente, HCA, America's largest hospital operator.

My suggestion is not just to accept the inevitable, but to take the lead.

Private equity deals with big investment banks are the answer, but of course we cannot ignore the big boys' of the likes of HCA taking an interest. This move will make our SHA the richest as we would have all the investors before the other SHAs get their wake-up call!

The downside is a squeeze on profits. Hospital operators are not free to charge what they like as is the case with the Post Office, British Gas, Powergen etc. However, 50 per cent of the hospital revenue will come from the Government which will be fighting to contain costs.

Medical machines, doctors' and nurses' salaries will continue to eat up revenues.

Uninsured patients will continue to pose a problem of bad debts.

Success does not come gift wrapped. Let us work for it.

DR F K B APALOO, Shear Bank Road, Blackburn.