Fleet-footed 'Billy'Milburn faces down the ballet-hoo

But I thought he was right to complain at the way Radio 4's To d a y handled NHS managers in the 81 (out of 123) UK health authorities which responded to its survey about winter prospects.

The fact that 71 out of 81 were 'very or fairly confident' that they are better placed than last year was swamped by crisis talk.

This is a problem. 'NHS winter crisis' is such an established media cliche that we can't leave it alone. It was evident again in Saturday's Daily Telegraph, which headlined an interview with the Geordie minister - who is now describing himself as 'the Billy Elliot of politics' (you'll have to see the film) - as 'NHS faces another bleak winter, says Milburn'.

All Billy Milburn had done was admit that 'it would be foolish to pretend that in parts of the NHS there won't be problems this winter'.

Buried away in the interview was a threat to impose a (staff ) training levy on the private sector - a better story, I'd say. But winter crisis is a better headline.

It prompted the normally level-headed Tory deputy health spokesman, Philip Hammond, to call it a U-turn - a sudden admission that the Brown Budget billions will not easily cure the NHS's ills. Hammond is on stronger ground, I think, in his running battle with health minister John Denham over the impact of the Care Standards Act on the 700 or so small residential care homes that have already closed in the past year.

Hammond says that the concordat will not resolve the NHS's bed-blocking crisis because the act is already persuading such care home owners to sell out (to property developers in boom counties) rather than invest capital in improvements. Why? Because of low returns.

The average social security payment for longterm or intermediate care of an elderly person is about£212 a week nationwide, or£1.40 an hour.

Supply is shrinking fast, he says.

More interesting last week were the Labour and Lib Dem dogs which did not bark over the concordat. I was surprised at the relatively modest coverage given to Mr Milburn's deal with the Independent Healthcare Association, those 100,000 extra treatments for NHS patients in the private sector. Only the Financial Times put it on page one.

All right, I know, the deal was signalled by Tony Blair in July. But I can't believe that David Hinchliffe's outburst ('very wrong') or Tony Benn's ('backdoor privatisation') did not reflect wider concerns - Frank Dobson's, for instance.

Hammond's boss, Dr Liam Fox, jokingly wound up Hinchliffe by telling him: 'I'm having trouble finding a health policy Milburn won't pinch.'

In fact when Mr Milburn saw Labour MPs in private (he made no Commons statement on the concordat), they took it pragmatically as 'a necessary evil' - a temporary expedient which will keep the NHS from being a problem during the imminent election. 'A toe in the Rubicon rather than crossing it, ' as one insider modestly put it.

But is it? Labour MPs were concerned that there is no time-limit on the concordat. And the Tories are saying that the Number 10 policy unit sees it as much more: as a head-to-toe crossing of Julius Caesar's famous river, one which will surely lead the NHS to become a commissioning body, purchasing services from a patchwork of public/private providers as in, say, Canada or the Netherlands.

There will be no going back now, they predict.

A PFI-built and run hospital for the NHS is next, says gossip. Milburn aides deny all this, just as they deny that Number 10 is driving the policy, politically convenient though that would be.

They do say that the NHS is already the purchaser of private services in much of mental healthcare and that the real Rubicon, the one they will not join the Tories in crossing, is who pays: taxpayer, not insurer. Don't forget, the private health sector in Britain is very small, Milburnites say. We're in charge.

I see. There was a young lady from Riga, who went for a ride on a pussycat. . .