John Reid, the health secretary, promised yesterday to light a bonfire of NHS targets in England to allow hospitals and primary care trusts more freedom to address local priorities.
He said national targets would be reduced to 20, compared with 108 when the NHS plan was introduced in 2000 and a current total of 62.
Mr Reid made no apology for the earlier proliferation of targets, which were criticised by the opposition parties for distorting doctors' clinical judgment and creating a tickbox culture in the NHS. He said strong direction from the centre was needed to overcome decades of under-investment and neglect.
But the government's aim in a third Labour term would be to disperse power to local trusts, recognising that the health needs of a former mining community in West Yorkshire were different from those in the commuter belt of Surrey.
The new targets include a pledge to achieve year-on-year reductions in the levels of the MRSA superbug.
For the first time there will be a specific commitment to address racial discrimination by addressing the disadvantage in healthcare faced by ethnic minorities.
Cutting waiting times is likely to become one of the core items in Labour's election manifesto. As Mr Reid put it, the aim will be "to ensure that by 2008 no one waits more than 18 weeks from GP referral to hospital treatment".
Most of the targets require improvements in results rather than merely promising more staff and resources.
Old targets such as the commitment that everyone should have access to a GP within 48 hours will become a "core standard" of the NHS.
The Healthcare Commission will monitor performance to ensure there is no backsliding on this commitment. But there will be no attempt to set even tighter time limits unless individual trusts choose to do so as a local priority.
The new system may be less centralised, but Mr Reid has not entirely let go of the reins. NHS trusts will not get funding from the government unless their local plans are approved by strategic health authorities.
They will also be expected to meet inspection standards, to be set by the Healthcare Commission.
In a framework document yesterday, Mr Reid set out principles for the commission to follow which seemed uncontroversial but vague.
The document included 24 core standards of this nature and 13 developmental standards to which trusts should aspire. The work of translating them into hard-edged performance measures is to be delegated to the commission.
Andrew Lansley, the Tory shadow health secretary, said: "No one should be fooled that the government is in reality cutting the bureaucracy it imposes on the NHS. Targets have simply been rebranded as standards."
