POLITICS MICHAEL WHITE

When Tony Blair told fellow EU socialists last month that we should try to be more like the Americans, I doubt if he had their medical litigation habits in mind. But even on days when there isn't a Bristol Royal Infirmary case being settled, there are worrying trends in the air.

It's a classic example of the law of unintended consequences. You tell voters their rights (as the Royal College of Nursing conference did again last week), you make procedures more open and doctors more accountable. Hey presto, people start to sue more.

Frank Dobson knows this because he keeps reminding staff not to leave the NHS vulnerable to claims. In a little-noticed report the other day, the National Audit Office warned the NHS that it will require even better risk management in the future, as money put aside for eventual settlements of 1998 cases virtually doubled to£145m.

Without wishing to sound sour, that puts some kind of perspective on the extra£120m (£430m over three years) which Gordon Brown found in his Budget, mainly for A&E improvements - waiting wards for people on trolleys and such like. It came from his previously announced capital modernisation fund. As such, it is new money in terms of the NHS, on top of the£30m down-payment announced by Tony Blair at Labour's Blackpool conference.

Even without Charlie Whelan's spin medicine, this was a brilliantly orchestrated Budget. 'Everyone a winner! There's real cash inside this Budget. Guaranteed prize for every reader,' roared The Sun, whose brutal propaganda machine is currently on hire to New Labour. Yet a week later things were not looking quite so rosy.

The law of unintended consequences is at work here too, as the chancellor tries to establish his green credentials by raising petrol and motoring taxes, and his Tessa Jowell credentials by slapping 17.5p on cigarettes to help reduce the NHS's cancer bill and save 120,000 lives a year. Lorry firms threaten to relocate across the Channel, and smugglers make arrangements to smuggle even more tobacco.

The message from Mr Brown is clear. Ministers may lecture Europe, but not all taxes are higher in Europe, Tony, and we learn from others. The Budget cash to expand NHS Direct, for example, owes its success to the US (where former health minister Alan Milburn saw it in operation); modifications are courtesy of Australia.

The trick, officials explain, is to keep patients away from doctors, let alone consultants. If they can be referred directly to the same physiotherapist they'd have been referred to by the consultant (referred, not 'palmed off', as Ann Widdecombe put it) everyone gains.

'The way to convince Tony and Gordon is to say 'Give us the money and we can show you that it has a demonstrable effect',' explains one Dobsonian ally. No abstract treatise from the NHS Executive will serve this purpose: the allocated funds must be tightly controlled, the areas of greatest need targeted and the benefits evaluated. Thus money for an elderly 'fallers clinic' in, say, Southampton must be shown to keep old people out of busy A&E departments.

Control, targeting, evaluation - these are very Brownite, New Labour- ish words. The chancellor busily withdrew universal benefits - on marriage, mortgages and the rest - and replaced them with targeted ones. Most RCN members will do a bit better from the Budget, I'm glad to confirm, and rather fewer London consultants, as money flows from the better-off to the poor.

We used to call it redistributive politics, which were very Old Labour - the Dobbo side of Mr Brown's complex nature. But when I asked the chancellor at his post-Budget press conference to confirm that Mrs White and I might be Budget losers he went all coy.

He just won't admit the R-word. I think that's a mistake, because it angers Tory voters when they read the small print, without reassuring Labour's own side. Candour is the best policy, as Mo Mowlam's recurring popularity shows. Talking of which, there is no Cunning Plan behind her unexpected but triumphant appearance at the RCN conference.

Cynical it may have been (who could boo Mo?), but the RCN has 10,000 members on her patch. My understanding is that Downing Street wants her for mayor of London, not health secretary. Dobbo may be safe after all.

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