Michael White on Darzi politics

Michael White

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Even before the saintly Lord Darzi uttered the first sentence of his latest report, or Henley had even voted, the Cameroon Conservatives had got their NHS retaliation in first.

It is like that with the Tories these days, they are on the ball and hungry for goals. They have made "polyclinic" as much a swear word as "targets" at by-elections now, making ministers keener to raise their own game. Hence the latest moves to make the reflexes of the National Institute for Health and Clinical Excellence a bit faster.

As HSJ readers learned last week, the Tory attack came in the shape of their own green paper, promising to match the best health performances in Europe, under the rubric "Outcomes not Targets". It was introduced in a snappy speech by the boss himself.

I thought it quite a solid piece of work with the serious intention not just of driving down over-reliance on crude targets but of providing measured outcomes to drive up clinical standards and give patients greater choice: transparency and information are its core.

Much easier said than done, but worth trying at this stage in modernisation. That was not all. Later in the week Andrew Lansley, health secretary-in-waiting, cheekily staged his own debate on the 60th anniversary of the NHS.

Alas, within a minute of opening, he unwisely provoked Labour nostalgics into the details of who said what during the second reading of the NHS Bill on 30 April 1946.

Let's not go there; even I was only six months old and quite indifferent.

But Alan Johnson's speech did unearth one historic nugget from that day. Criticised by the British Medical Association, his predecessor, the even saintlier than Darzi (though not such a good surgeon) Nye Bevan remarked that rows with the minister could hardly be "a consequence of any deficiencies I possess, because we have never been able yet to appoint a minister of health with whom the BMA agreed".

Some things don't change then: the BMA, beset with problems of its own, is on the warpath again. But it would surely strike the wrong note if we stress party conflict in 2008. Despite the rhetoric and rival ways of achieving health goals, we are close to a broad consensus on those goals and problems between the front benches. Yes?

True, socialists in the Labour and union ranks still want to exclude private sector participants while free market purists want to go further than merely demolish what David Cameron loves to call "Labour's bureaucratic, top-down, centralised" model in favour of new localism. But they are differences within parties which steady nerves can resist.

Localism too will be harder to do than it looks. Mr Lansley's speech deplored Labour's public health failures, but he is too smart not to know how entrenched some of our unhealthy lifestyle habits ("pass the claret, Maud") now are. Watching a seriously fat child in the swimming pool the other day, I wondered just how our me-me consumer society will manage to thin him down.

A suitably cautious footnote came from the Labour-leaning Institute for Public Policy Research think tank last week. Private spending on healthcare, user charges and insurance is not the panacea the right thinks it is, wrote researcher Joe Farrington-Douglas, but should not be cold-shouldered either.

The challenge is sector "synergies" such as using the workplace to promote preventive health. Sounds OK.