Michael White on the big split over ISTCs

The health secretary told his advisers he regards Lansley’s attack as “desperation”, since he can point to a long record of reforms. On the BBC Nick Robinson explained it was really nothing to do with the NHS (silly me!), more a pre-emptive strike against Johnners, the silver-tongued PM-in-waiting whom the Tories fear.

It is cheeky of Lansley to attack the health gap because neither the Tory record (1979-97) nor their current policies point to them doing better.

But the choice issue, recently highlighted by HSJ reports is interesting.

So I rang MPs across the party divide to see how choice and local independent treatment centres had affected their constituents. The answers vary hugely.

Wyre Forest’s Richard Taylor, himself an independent, reluctantly concedes (“I am very pro-NHS”) that the InterHealth Canada centre located in an empty ward at Kidderminster Hospital (which he fought to keep open as an acute centre) has done a “very good job” replacing hips and knees, fast and well, without the high failure rate experienced elsewhere.

But Dr Taylor notes a point made by other MPs, that the independent centres get the easier cases, younger patients too, leaving the older, high dependency ops to the nearest big NHS hospital. His worry is whether the PCT will renew the contract and, if not, whether surgeons from Worcester and Redditch really can and will do what they say they will in Kidderminster.

In Reading, the attitude of Labour’s Martin Salter could not be more different. Neither choice nor an independent centre has made much difference, he says in a tone which echoes his chum, Frank Dobson, who funded the major upgrade at the Royal Berkshire in 1997. “People don’t want choice, they want a good local hospital.”

Oddly enough, when I traced Patrick McLoughlin, Tory chief whip and a level headed ex-Derbyshire miner, he was not ecstatic either. One eminent consultant in his patch is always telling him that the Barlborough centre has been a waste of time and that the NHS gets dumped with the problems.

On the other hand voters rarely speak out when things go right, he notes sadly. He gets no complaints. Nor does Alison Seabeck, Labour MP for naval Devonport, whose Care UK Peninsula centre she reckons has helped “rip through the waiting lists on less complex knees and hips. The overwhelming response is that it’s where people like to be”.

By that she means speed and quality, plus four-bed wards (not six).

Derriford Hospital, which used to have an MRSA problem, is much better now she says, and Exeter is nearby. You don’t get the complaints she heard when she was an MP’s secretary in London.

In the North East, Newcastle Central’s Jim Cousins says the city’s foundation trust has long bought spare capacity from local Nuffield hospitals, before the Cobalt independent centre arrived, while doing the riskier cases itself. Choice has proved “quite successful” in cutting long orthopaedic waiting lists, the MP says, and patients can opt to go to Hexham. On balance, competitive pressures have been positive.

Cousins goes further than other MPs in detecting a shift back to the public sector in both health and education, a combination of better services and recession. That may be wishful thinking. The NHS has always been good in the region - one of its many secrets.