opinion

Two sentences leapt out of Tony Blair's latest Big Speech on improving Britain's public services, which you may have missed because it appeared on page 99 of our great national newspapers after the daily ration of Taliban Tales.

One sentence was, 'the key to reform is redesigning the system around the user' - ie putting customers (the new Milburnian watchword) first. It was closely followed by the cryptic remark: 'I do believe, incidentally, that people can be persuaded that they have to pay for good public services.'

It was that utterance that triggered a plethora of 'higher taxes' headlines, a story that always excites editors, fearful of losing a little more of their ill-gotten gains. I have no doubt that taxes will rise in the next couple of years, not least because of the economic downturn which Mr bin Laden has made worse.

But unless Alan Milburn has misled me or (equally unlikely) changed his mind, I discount weekend suggestions that he is backing the concept of hypothecation - a politically acceptable way of raising taxes, according to the Fabian Society and other pointy-heads.

In fact, what caught my short attention span was when Mr Blair posed the question of whether insurance or tax pays for healthcare. 'For reasons of equity and efficiency - never forget the NHS is renowned worldwide as immensely costeffective, if under-funded - I prefer the latter route.'

How often they discuss the cost-effectiveness of the NHS in the GP waiting rooms of Cairo or Kabul, I do not know.

But It is a pat-on-the-back point worth making as the pressure increases to make excellence the norm rather than 'too thinly spread', as the PM puts it.

You could see the pressure and the pitfalls when Mr Milburn faced Commons questions for the first time since July: a stream of inquiries about maternity services, Hepatitis C and the rationalisation of specialist hospital services. Local MPs naturally interpret such talk as the closure of a local facility, the cancer centre at Mount Vernon in west London or Burford Community Hospital up the M40 into Oxfordshire. Faced with an onslaught on politically dictated (ie waiting time) delays for elective heart surgery - from Dr Evan Harris, the Lib Dem health spokesman - Mr Milburn combined candour ('people wait far too long for a heart operation in this country') with reassurance that years of neglect are being addressed at last. Nor did the bare-foot doctor (do I mean bare faced? ) forget the humble aspirin.'In the last year alone, the number of prescriptions for statins [which lower cholesterol] has increased by 37 per cent...' 'We all know that although it is often the glamorous side of cardiac care that attracts most attention, actually the biggest improvement we can make is often in primary care, ' the secretary of state told MPs.

This in a week when the breast screening row resurfaced and 25 per cent of GPs were said to be keen to quit within five years. It is going to be a long war, as Mr Blair keeps saying in another context.

Not that the health questions avoided that conflict either, since Dr Liam Fox popped what looked like a pre-arranged question Mr Milburn's way about emergency responses to 'a biological threat such as anthrax'. The minister duly reassured as best he could.

We all know a lot more about anthrax than we did 10 days ago. Even reading about envelopes full of white powder from the safety of 3,000 miles can give you secondary symptoms known as hysteria. As I write, Radio 4 is reporting that the US has plenty of antidote, provided that doctors - whose system, Mr Blair, has long been 're-designed around the user' (often with disastrous results) - do not sell it all to jittery patients who do not have anthrax poisoning.

I am reminded of the remark by fellowscribe turned best-selling novelist Robert Harris, who said that the Afghan crisis shows how globalised the world now is. 'A maniac in a cave sends planes crashing into buildings and, literally within hours, you find you can't sell your house.' Or get to see your GP?