By Nick Triggle Health reporter, BBC News

Health will be keenly debated at the Labour Party conference this week.

That is not surprising as hardly a week has gone by this year without the NHS headline news.

Chancellor Gordon Brown, for many the apparent prime minister in waiting, is considering plans for an independent NHS board.

And the conference will hear other ministers' proposals for an NHS constitution, like the BBC charter.

But the government has already introduced root and branch reform of the health service. Just what has been the impact, and is it fair to say the NHS is in crisis?

Hospitals are facing cuts to services

First it was deficits and now there is the first national strike in the NHS for nearly 20 years.

And the worst may be yet to come, with the new NHS boss, David Nicholson, warning hospitals may be stripped of many of their key services.

Predicatably, the government says it is all part of its plan to reform the way care is provided.

Ministers say they want to see more people treated in the community and out of hospital so it is logical to see services such as emergency care centralised in fewer hospitals.

The opposition are having none of it, scenting blood, they claim the government has lost control.

So what is the truth?

'Fast enough'

Henry de Zoete, of centre-right think tank Reform, believes the problem, if any, is that the government is not going far enough, fast enough.

"In many ways we believe the government has got to be bolder if it is to get this right.

"Increasing use of the private sector, more market-based reforms and hospital reconfiguration is the right way forward, but ministers should not be too shy about it."

But the experiences of health bosses in Greater Manchester illustrate the difficulties the NHS faces when it takes the bull by the horns.

They have announced that one of the four hospitals run by the Pennine Acute Hospitals NHS Trust is to be stripped of services, such as A&E and emergency surgery.

2006... FROM BAD TO WORSE March - April - Thousands of jobs losses announced by hospitals in bid to save money April - Nurses barrack the health secretary, forcing her to cut short her speech at their conference June - The NHS deficit tops �500m, the largest in recent years, prompting more negative headlines August - Local managers start to discuss closing and downgrading hospitals September - First national NHS strike for 18 years as supply staff walk out CPS:LINK HREF="" ID="5373096" STYLE="rightarrow">Why an independent NHS board?

In doing, so they will create what they are dubbing the country's first "locality hospital" concentrating on social services and mental health.

The final decision is expected by the end of the year, but it has already attracted a lot of criticism locally, especially since the NHS trust is facing a �28m deficit.

The proposals will end up reducing the deficits, but managers are quick point out it is being motivated more by a desire to move care out into the community and get around EU working restrictions, which are forcing doctors to reduce their hours.

Tim Presswood, chairman of the committee overseeing the changes, acknowledges changes have brought about "uncertainty and concern".

But he added: "Planned change has to happen. Allowing services to continue the way that they are currently structured is not an option as all services are facing great pressure."

However, the government and NHS managers are not finding it easy to convince staff.

Dr Barry Monk, a dermatologist at Bedford Hospital, which is facing an uncertain future, has announced he will be standing for election on the ticket of saving the hospital.

He said doctors have had enough and urged them to follow his lead by interfering in the "cosy world of politics".

Strike

And hundreds of workers from NHS Logistics, the health service's supply agency, walked out last week and will do so again on Tuesday in the first national strike in the NHS for 18 years.

They are objecting to the sell-off of the agency to private delivery firm DHL - and while this is not directly related to hospital cuts it is symbolic of the unease felt towards the increasing role of the private sector, another of the government's health reforms.

Jonathan Fielden, deputy chairman of the British Medical Association, sees difficulties for the government.

NHS Logistics staffed went on strike last week

"If the changes are well planned, I think many doctors could support them. But what we could end up seeing is hospitals losing too many services because of the financial pressures.

"And that is where staff start to get agitated."

Joe Farrington-Douglas, a health researcher at the Institute for Public Policy Research, agreed.

"If they don't take staff with them, it could be very damaging for their reforms. What we need to do is allow decisions to be made at a local level, give them ownership of it."

But he cited the barracking the normally-moderate Royal College of Nursing conference gave Health Secretary Patricia Hewitt in April as an illustration of the task facing ministers.

Nigel Edwards, director of policy at the NHS Confederation, calls it a "curious paradox".

"At a time when waiting lists are falling and huge amounts of money have been invested, the government is struggling to convince people they are doing the right thing for the NHS.