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Michael White on Darling's budget

By the time you read this, Alistair Darling's first Budget will have reinforced Gordon Brown's latest promise to make our great public services more competitive and accountable to their customers. They are all Blairites now.

Quite what the chancellor has done to prod schools, hospitals, GP surgeries and the rest in that direction is known to you, but not yet to me as I type this article. It is my annual Week of the Great Ignorance. But no-one has been denying that it is a tough year for budget making: though Mr Darling can't say this, his predecessor left him with little room for manoeuvre.

On the tax-spend-borrowing front, chancellor Brown long ago pencilled in a gentle squeeze for 2008-11 after his NHS spending splurge. As things have turned out, a spot of fiscal stimulus might have been handy as Britain heads into what may be a recession like the one the US seems to have entered since the sub-prime mortgage crisis. But we are over-borrowed.

Meanwhile, the PM took the pre-emptive chance of an FT article to assert that extra investment since 1997, plus the drive for better performance, have shifted the public services from "below average in 1997 to above average now". It is not something everyone would accept, including many peers who debated the NHS the other day.

Phase three is to "further enhance choice but also empower both the users of services and all the professions who deliver them", wrote GB. "There can be no backsliding on reform, no go-slow, no reversals and no easy compromises," by which he means more check-ups, shorter waits, a choice of hospital, better GP services etc etc.

We've heard it all before but must travel in hope, unlike another FT columnist the other day whose analysis seemed over-dependent on Lost Decade, a gloomy report from the free-market think tank Reform. I'd recommend Prozac if we still thought it worked.

So, improvement is incremental. Strange to report, the latest prescription charge increase for England, from£6.85p to£7.10, is consistent with the Brown world view: targeting the neediest (actually 88 per cent of scrips are free) and raising£435m, plus whatever GPs generate. Quite right, too: the Scots and Welsh free scrip policies are kind but wrong.

As it happens I took the precaution of re-checking the Lords debate in which Lord Mancroft's lively attack on "grubby, drunken and promiscuous" nurses was wrenched from wider context by skilled media surgeons.

Were his comments all that negative? No, of course not. Even Lord M extravagantly praised the treatment he got when his wife "kidnapped" him and took him to the Chelsea and Westminster. Nurses were "marvellous", hospital "spotlessly clean" etc. One extreme to the other, the ninny.

Fellow peers ignored the Tory hereditary, whose listed interests include drug addiction and alcoholism and whose recreations include huntin', shootin' and fishin', as some aristos like to put it. But a couple of their own more measured complaints are worth recording.

Lady Eccles, the veteran Tory great-and-good peer who launched the debate, made so many sensible points about devolving decision making, speeding up IT programmes and the need for better-trained nurses that Labour's medical heavyweight, Lord Rea, could barely disagree.

More sadly, he conceded that OECD data more objective than Lord Mancroft shows that Mr Brown's improvements since 1997 still have a long way to go to be world class. GPs had "outsmarted" NHS pay negotiators over that new contract, he said.

Yet several peers wondered if the Brown-Johnson drive to force GPs to open longer hours was the best use of expert time and money. Some 84 per cent are happy with current hours, only 4 per cent want evening openings and 7 per cent Saturday mornings, said Tory spokesman Lord Howe.

Does that mean well-meaning ministers are making bad, evidence-free policy, just as they may be in closing small-but-popular maternity wards? And what about junior health minister Lord Darzi's review? Peers love him, but will his review be over prescriptive, which is what GB says he doesn't want for public services? Only asking.

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