1.13 The uncertainties in local long-term strategy mirror those in London and the NHS as a whole. EHH Health Authority issued five-year plans that describe high-level intentions for responding to local healthcare needs. They refer to the redevelopment of West Middlesex and the rationalisation of services, but there is little detail to show how this fits in with an optimum local plan for health services. Primary care groups and community health councils have been sceptical about the existence of a coherent and integrated local healthcare strategy covering all existing and anticipated future needs and provision.