Historic turning-points are usually the stuff of brash PR fanfares under New Labour, especially if they have anything to do with the NHS. Strange, then, that last week's should pass virtually unheralded.
In case you missed it, we refer to the end of three-and-a-half remorseless years of management cost cuts. Using that most low-profile genre of political announcement, health minister John Denham revealed the decision in a written parliamentary answer. Figures purporting to show that trusts and health authorities were on target to make the promised£1bn savings in 'bureaucracy' were apparently published simultaneously - though no-one we contacted had received a copy - accompanied by a laconic 12-line press release which mysteriously took five days to travel the two miles from Richmond House to HSJ's office.
Why such unwonted reticence at this achievement when the government previously made such a hullabaloo about slashing bureaucracy? Could it be that ministers fear their figures will not bear too much close scrutiny? Those with a more detailed understanding of management costs have always snorted sceptical derision at government aspirations here. Rhetoric about fat-cat pen-pushers may play well in the tabloids, but the reality of running a large complex organisation means high-quality managers - and plenty of them, especially at times of major change. And sure enough, the figures show a£19m rise in cash terms, though in real terms they are down.
Few managers will quibble about how the government has rigged the figures to achieve its election promises, given that Mr Denham has decided to end the much resented purge which began in 1995 under the then health secretary, Stephen Dorrell - prompted, ironically, by Labour taunts about the internal market leading to the proliferation of grey suits in the service. But it would have boosted morale if ministers had been a little more open and a little less grudging about acknowledging how important management spending is to the NHS after all.
Up to 280,000 refugees may have settled in the capital since 1983, according to astonishing estimates by the Health of Londoners Project (see news focus, pages 12-13). That amounts to the population of a large town. Yet little reliable information exists about their health needs. Until now, this has been a matter important only to the NHS in London. But once the Asylum Bill becomes law, the government intends to disperse refugees more evenly around the country. If the NHS is to serve them properly, it needs to attach a higher priority to collecting data about them and their state of health.
Many refugees and asylum-seekers are undoubtedly attracted to Britain because they perceive it as embodying values such as respect for human dignity, democracy, choice, equity and universality - all values which figure prominently in a report this week from the Institute for Public Policy Research and the King's Fund on the NHS's 'moral basis' (see news focus, pages 10-11). If, as former chancellor Nigel Lawson once remarked, the NHS is the nearest thing the British have to a national religion, then the service's moral basis must form the founding tenets of society's creed.
Religious beliefs, of course, represent ideals which are not always matched in practice. Probably most NHS staff would endorse the IPPR and King's Fund values as befitting the service, but few would argue that it lived up to them in all instances. Perhaps many refugees find from their experience that Britain fails to live up to the values they had assumed were its guiding principles. But it would be a noble accomplishment if they were to find that the NHS did in how it cared for them.
In search of value-added Britain
The NHS may encapsulate the moral tenets that refugees hold so dear