Published: 15/07/2004, Volume II4, No. 5914 Page 19

Who said last week: 'By giving people more control and allowing them to make decisions, we will create competitive pressure for excellence'?

I'll give you a clue.He went on to say: 'We will also make it possible to do away with layers of bureaucracy [in the NHS].'

Yes indeed, you're right. It wasn't health secretary John Reid in modernising mode, but shadow chancellor Oliver Letwin, speaking with Tory health honcho Andrew Lansley at his side.

Little wonder that shadow education secretary Tim Collins jeered that his Labour counterpart Charles Clarke's schools plans owed 'more to the Xerox copying machine' than to the Labour party.We shouldn't exaggerate because, even in a market-solution era, significant differences remain between the parties: not least how private sector service provision will be funded and managed.

The Tories are vulnerable to twin charges here: that even when they are not mad taxcutters, they will pour extra money into an under-regulated private health or education sector, as they did into the portable pensions industry with scandalous results in the 1980s. But, as HSJ editorials remind us, ministers seem happy to nick good ideas.

The Letwin-Lansley plan to cut£1.7bn worth of 'bureaucratic costs' from the NHS largely fits this template. Since it got little publicity, let me repeat: it would further hammer primary care trusts by removing commissioning functions, first on elective care, then on all planned care. It would save£1bn and be another 'nail in the PCT coffin' which HSJ noted only last week.

Talk of 'practice-led commissioning'with GPs free to refer patients seems to revive GP fund-holding. The abolition of strategic health authorities, their residual functions merged with bigger PCTs, would save£100m;

cuts in NHS quangos which have 22,000 staff and spend£2.5bn, many Labour-created, would save£650m, and£50m will be shaved from the Department of Health's own staff levels and functions.

Who says all this, by the way? A team of bright boys led by City troubleshooter David James, whom the government itself called in to stabilise the Millennium Dome. Smart blokes working for free shows the Tories are back in business.

But the Tory 'right to choose' is an echo of Maggie's 'right to buy' council houses, which proved so significant only in retrospect.

Their familiar attack on pen pushing ('the civil service is now the size of Sheffield') will not yet win elections.Voters are still sceptical. And there is still life in the Labour dog.

Thus Mr Letwin's plan to redirect savings to our old friend frontline services was barely dry on the page before Gordon Brown's spending review capped it on Monday: the chancellor promised to double the 40,000 civil service jobs he had promised to axe on Budget day.

He has yet to deliver, of course.

So has Mr Letwin.

But Mr Reid is busy cut-andpasting, too. On Monday he moved to extend patient power and choice - the word of the moment - to a favourite Daily Mail bugbear: hospital infections, which recently had distinguished ex-nurse-turnedlovable-agony-aunt Claire Rayner telling it she would double her mortgage rather than risk another NHS ward.

That seems a bit unfair of Ms Rayner. By her own account she has had a dozen NHS operations lately - cancer, knees, cataracts and Achilles tendon - as well as MRSA and survived them all.

Never mind.Mr Reid can spot a hot and real problem. It is, after all, not the first time ministers have been on to i t .

So nurses will be encouraged to wear badges saying 'ask me if I've washed my hands'. It all sounds very touchy-feely, but my man at the ministry says it has been successfully piloted at University Hospital Lewisham in south London.

'We have got to get the science right and We have got to get the culture right. Patients often find it hard to ask the staff about washing their hands, ' he says. So there will be extra inspections and a hotline.

Tomorrow Mr Reid will turn Labour's spotlight on NHS dentistry, an even tougher nut to crack.

But will ministers also tackle abortion, as reported? No. Tony Blair was manoeuvred into saying that, if science can now save babies at 14 weeks (it can), something might have to be done. But surely not this side of polling day!