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Michael White: budget politics

No point in spending too much time on this year's Budget, I think, which wasn't much of an NHS event anyway. I'm all for optimism about the future, but Alistair Darling's low-key confidence a week ago has already been overtaken by the gathering financial storm in the Atlantic. Fasten seatbelts.

All the same, a couple of points are worth making. The chancellor didn't pretend that his extra pennies on booze 'n' fags were for health reasons or to curb the 24/7 binge drinking incidents which are cluttering up accident and emergency (up 26 per cent since 2005, claims a new report). They were to raise a little money.

Mr Darling used that money to help tackle poverty, which should benefit A&E indirectly. So should cleaner air quality from gas guzzler taxes. He also postponed new accounting standards for public sector capital investment - in other words, NHS private finance initiative projects - a topic which is way above most MPs' pay grade (and mine).

What he didn't do was what his Tory shadow George Osborne claimed he did on day two of the Budget debate, which was to cut NHS spending by£1.3bn, including£700m of capital spend compared with last November's pre-Budget report.

Ex-health minister Jane Kennedy, now financial secretary at the Treasury, told Master Georgie that he had "completely misunderstood how the public spending tables work". Underspends are carried over as part of what is now known as EYF - "end year flexibility". This is meant to discourage reckless year-end spending (shame to lose the cash) and instead allows spenders to re-bid for it.

So, as promised, health is still to get an extra 4 per cent a year until 2011, close to the figure proposed by Sir Derek Wanless, the (Northern Rock) banker who examined NHS funding for chancellor Brown. So "massive increase, no cuts," as Ms Kennedy put it.

What's frustrating to report is that Mr Darling had just slipped into the chamber to listen to the debate when Mr Osborne made his mistake. Yet he didn't get to his feet and reproach the cheeky youth: not his style, I fear.

Senior Tories, Mr Osborne included, were on firmer ground at their party's spring conference in Gateshead at the weekend. While the Treasury team warned party activists not to expect early tax cuts from a Cameron government, the leader himself polished his family-friendly credentials.

Mr Cameron shares Labour's belief that the early years are crucial to a child's prospects, but not its faith in hiring more Sure Start outreach workers, untrained as many are. Instead we need more health visitors, highly trained NHS professionals who come to your home and build a strong relationship with your family, he explained.

But under Labour, the number is in freefall. Many are set to retire, with no plans to replace them. It's got so bad that in some parts of the country you're lucky to see one at all. Result? Avoidable illnesses, poor diet, even rickets.

That sort of talk from the Tories seems sensible to me if they are to rebuild public trust. Mr Cameron in his Gateshead speech said they must by way of admitting their past errors and generating what he called "bottom-up, not top-down" change.

Easier said than done, I know. If this week's proposals from Dame Carol Black's review of occupational health, to save£100bn on aches and pains that keep us off work, are to get off the ground, it will need initiatives at the centre. Health secretary Alan Johnson's "well notes, not sick notes" speech last month points to official approval.

But when they think no one's looking, politicians can co-operate beautifully for the public good. On a quiet day last week the obstetrician, Lord Patel of Dunkeld, a pillar of the medical establishment, launched a Lords debate on Sir John Tooke's report into last year's medical training disaster.

It proved a model of cross-party civility, which notes Tooke's conclusion that (as one peer put it) "no one comes up smelling of roses". Lord Darzi's summing up reminded listeners that the old system had been "neither transparent, nor fair". As ministers implement Tooke, many of their lordship's concerns will be reflected in his own report. "Darzi Two" as they call it.

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