And they're off - they've started so they'll finish

We can put aside windy diversions over chicken tikka massala, nuclear weapons and Tony Blair's new specs. This election takes place in an increasingly prosperous country in which most consumers have more money to spend on dafter and dafter things, but public services remain woefully dysfunctional.

A truism, I know, and Loyd Grossman's new NHS menu will not change things overnight.

Blair is acutely aware of all this - Hague and Kennedy, too, from their rival perspectives.

Hours before that final announcement, Mr Campbell told reporters how the boss wants to make the campaign a crusade to 'restore public faith in the public services' as his invest-and-reform policies start to produce results. Coincidentally we had several glimpses of how hard that will be.On the one hand there is renewed militancy in the ranks of the British Medical Association - witness some very bitter letters in the broadsheet newspapers, whose authors will be lying in wait for Alan Milburn when he returns to his current day job (as I think he will) after polling day. At the same time, The Spectator ran a persuasive interview with a 31-year-old surgeon poised to quit over low pay, bureaucracy, dirt and poor post-operative care (all those agency nurses) in his London teaching hospital. It was a grim read.

The medic blamed Ken Clarke's internal market reforms of 1990 for starting the rot which has destroyed team spirit in the NHS, but accuses Labour of hectoring interference too.

In the Lords last week Baroness Noakes, formerly Sheila Masters, formidable accountant and quangocrat who was NHS finance director (1988-91), made similar points about morale on the wards, and even included the low morale of managers.

A steady trickle of resignations, 'scapegoating on an unprecedented scale... targeting and priorities raining down from on high...' She quoted one senior manager as saying:

'You are always being watched. But It is not just that, It is the number of people watching you.'

Yes, the baroness acknowledged Milburn's 'Damascene conversion' the other day, his move to devolve power. 'But this promises yet more reorganisation. My instinct is that the burdens on managers will be increased in the short-term for little or no long-term gain, ' she predicted. It was left to junior health minister Lord Hunt to assure fellow-peers that people were saying the same when he joined the NHS in 1972 (when Sir Keith Joseph was reorganising the system). 'I have never been more confident about its future than I am today, ' he added.

We are back to the 'glass half-empty or halffull' point which Mr Milburn and Tony Blair both like to make. Being an instinctive halfempty man myself, I admire the half-full crowd for their optimism. 'Pessimism of the intellect, optimism of the will, ' as one Milburn-ish Italian Marxist once observed.

The trouble is that consumer-driven reform generates high expectation and demands for compensation when clinical error is exposed on what is becoming a frightening scale: it is harder for doctors to bury their mistakes, Hence the alarming pre-election reports that the NHS's potential liability is£4bn, 10 per cent of the budget, with payments tripled last year. There is a wider trend here. The families of an IRA murder squad got£10,000 apiece last week from the European Court, and lawyers were queuing up to tell anti-capitalist demonstrators how to sue the police after May day.

Listening to a cynical lawyer on the radio reminded me how, 15 years ago, Ralph Nader, the anti-Gore radical candidate who helped elect President Bush, told me that suing doctors kept them honest. US medicine has been crippled by that approach, and it is creeping in here, thanks to the growth of the contingency fee (you only pay if you win), and encouraged by New Labour to save money on legal aid.

Lawyers are the real winners. So Mr Milburn was right to complain about ambulance-chasing posters inside hospitals.We wouldn't want Loyd Grossman sued for serving a flat soufflé on Bevan ward.