But the agenda has been dominated by two main stories: the Bristol babies case and Viagra.

Both are likely to make a big impact in 1999.

The inquiry by the General Medical Council (GMC) into the death of 29 children following heart surgery at Bristol Royal Infirmary finished in the summer, but that was only the beginning of the story.

Mr Janardan Dhasmana: found guilty of serious professional misconduct

Two surgeons and their manager were found guilty of serious professional misconduct by the GMC.

The surgeons, Mr Janardhan Dhasmana and Mr James Wisheart, were found to have continued operating when they had a much higher than average death rate.

Their manager Dr John Roylance was found guilty of not doing anything to stop them operating.

Public inquiry

A preliminary hearing of the public inquiry into the case opened in October, but the real action begins in the new year.

The case has brought the medical profession under public scrutiny as never before and the whole basis of self-regulation has been called into question.

The General Medical Council has issued guidelines on how the profession can try to ensure a similar case does not happen again.

The royal colleges have called for regular check-ups on doctors' skills, but are still debating how this can be achieved.

And the Department of Health has taken several steps to tackle the problems.

Next year will, for example, see the publication of the first hospital league tables to measure clinical performance.

The government hopes this will encourage hospitals to improve their performance.

But doctors warn that the tables are too simplistic and could encourage hospitals to steer clear of more complex operations.

Improving standards

The government also expects that the new National Institute of Clinical Excellence and the Commission for Health Improvement will improve standards as well as ensuring more equality in the distribution of medicines.

Many charities working in the health field have expressed concerns about drugs being rationed according to postcode - with some areas of the country being able to get new drugs while others are denied access.

No issue has focused the public mind so clearly on drug rationing as the debate over Viagra, the impotence pill.

Early in the year came the hype about Viagra, but it was not until September that the drug was licensed for sale in Europe.

However, the government placed a temporary block on prescription of the drug on the NHS.

The government will target anti-smoking campaigns at the young

It said it would give detailed guidelines shortly, but none had been given before Christmas and doctors are threatening to go ahead and prescribe it anyway.

The government's main concern is that demand for the drug will be so high that it will take up a substantial amount of the NHS drug bill.

One in 10 men in the UK is estimated to suffer from impotence.

Some doctors say Viagra is just the first of a new wave of "lifestyle" drugs which improve people's quality of life but are not life-saving.

They want a general solution to the problem of drug rationing.

Tobacco

The other main health stories of 1998 include:

• the long-awaited White Paper on tobacco. This provides £110m for programmes reducing smoking, particularly among the young and deprived
• the start of the inquiry into BSE
• the mental health strategy which includes a £700m investment in mental health provision and more emergency beds and support for the mentally ill living in the community
• the comprehensive spending review brought an extra £21bn for the NHS in England and Wales over the next three years
• Sir Donald Acheson's year-long report on health inequalities highlighted the growing health gap between rich and poor
• all this and the 50th anniversary of the NHS too.

Next year will see the implementation of many of these policies.

In the mental health strategy, for example, the government announced a review of mental health legislation with a view to making it possible for people with mental health problems to be sent back to hospital if they do not take their medicine. This will report by the summer.

Primary care

By April, the NHS should begin to register the impact of the extra money announced in the comprehensive spending review.

But the big health issue will undoubtedly be the setting up of the new primary care groups.

These will include doctors, nurses and other health staff who will be given responsibility for commissioning care for other health services.

Doctors fear they will be forced to carry the can for rationing decisions and will be overburdened with paperwork.