The Labour government shows plenty of signs of being on its last legs.
So my constant worry is that the Tories are still not ready to take over - as Tony Blair was in 1997, whatever you think of his evidence to the Chilcot inquiry.
Naturally, the Tories have taken up the Mail’s campaign
On Radio 4’s Today programme Andy Burnham sounded hopelessly defensive when challenged to justify Labour’s hasty and undercosted legislation to extend free personal care to vulnerable elderly people in England. Electioneering or what?
But the health secretary was also hammered by the Beeb’s rampaging John Humphrys about the “crisis” over GPs’ out of hours services. Again he went on the back foot, even though Labour has a much better story to tell than you would guess from the Daily Mail.
As I type the Mail has yet another “crisis” report: some areas have just one night doctor to serve 300,000 people. Complaints are “up 50 per cent” the paper reports - 517 in 2007-08 compared with 337 over the two previous years, the first years after the 2004 Carson reforms.
Naturally, the Tories have taken up the Mail’s campaign, fuelled by the death of 70 year old David Gray at the hands of a tired locum, Daniel Ubani, who happens to be (a tabloid double whammy?) both German and black. Out of hours deaths have led to 17 legal claims.
Yes, there are grounds for concern, MPs agreed when the opposition launched another Commons debate the other day. I will come to them. But context matters because the tabloids peddle a “golden age” myth.
Complaints had mounted during the Tory 1990s when GPs were still responsible - legally - for night cover mistakes, but only 5 per cent still actually saw their own patients. Locums, co-ops, private firms saw most. But patients were getting more articulate and demanding.
It led to the Carson review’s conclusion that the old system was unsustainable. As part of the new and luxurious GP contract in 2004 they could contract out for a modest £6,000 a year: they rushed to grab a bargain. Primary care trusts took over responsibility - with what we now know are mixed results.
Mike O’Brien, Handy Andy’s deputy, reminded MPs there are three safeguards between a David Gray and a Dr Ubani: the General Medical Council checks qualifications; the PCT has a legal obligation to check “performers list” competence, which includes competence in English; and so does the rentalocum firm which employs them.
Ministers can fairly claim to have constantly monitored the new system; indeed the Care Quality Commission is on the case too.
There are some excellent systems - Basingstoke’s tied into the local accident and emergency department, for instance.
MPs pointed up weaknesses, the sheer size (said Sir Alan Beith) of rural areas; weaknesses in what Labour’s Mark Todd called “knowledge transfers” - accessing files of previously unseen patients.
Am I being unfair in saying Tory MPs, including frontbencher Mark Simmonds, were keen to stress the “foreigner” problem? It is real, but complex too. Top rate and fluent Indian doctors still have to go through UK hoops that European doctors don’t. What is more there is no EU-wide obligation to report a doctor who is struck off. PCTs’ tests vary too much, as do their out of hours costs. Some doubtful applicants shop around.
So is the system much better than pre-1997, but needing work? I suspect so. The Tory remedy is greater doctor involvement in commissioning (and legal responsibility). Fine if they want it. But remember: more localised decisions equals more postcode lottery. It’s just what the Mail is complaining about.