Published: 29/01/2004, Volume II4, No. 5890 Page 20
In the run-up to the twin dramas over Hutton and student fees, the bitterness seemed to spread like water from a frostburst pipe.
That medical student who challenged prime minister Tony Blair on BBC's Newsnight exemplified some of the problems for both sides.
'It really infuriates me that you say: 'Why should the dustman fund the doctor?'When he has a heart attack he'll be pleased that I went to university, graduated as a doctor and therefore he should contribute towards the cost of my degree, ' Julia Prague told the prime minister, after he pointed out that most people still do not go to university but do pay taxes.
Lots of people agree with Ms Prague, who apparently comes from a modest background.
The British Medical Association later weighed in to say that doctors would graduate with£64,000 worth of debt - falsely, health secretary John Reid quickly replied.
Lots do not agree with her. 'Julia has learned quickly the insufferable arrogance of her chosen profession' wrote the Sunday Mirror's redoubtable columnist Richard Stott.
The nastiness also seeped into health question time. Health ministers had to force off challenges over decisions by local NHS management on issues as diverse as stars for hospitals which are over-dependent on costly agency nurses, to poaching South African nurses, which Nelson Mandela himself asked us not to do.
The issue which caught my eye was raised by Labour MPs concerned with patient involvement.
Some 99 per cent of places on the new patient forums have been filled and 'thousands of people have applied to become members of the first wave of foundation trusts', health minister Rosie Winterton told the House.
She faced polite scepticism about levels of involvement from MPs in all parties, including Plaid Cymru MP Hywel Williams, who pointed out - a touch smugly - that Wales has retained community health councils. And a pretty dodgy health performance, the MP failed to add.
Coincidentally Alan Milburn, late of this parish, made a big speech about what is known as the 'new localism', the attempt by Labour ministers - shadow chancellor Oliver Letwin, too - to bring decision making and accountability closer to the grassroots on health, council services like education, even the police.
A good point in a week when some people personally blamed Mr Blair for not intervening to stop Professor Roy Meadows' theories on parental violence to children being believed by the courts. For heaven's sake, what are lawyers and doctors supposed to be for!
Mr Milburn's speech argued that localism is a response to globalisation and also to consumerism. It has created a local political battleground which 'the Liberals feel naturally is theirs'.
He didn't add that, in some parts - where failing Tory and Labour councils have been replaced by the Lib Dems - the BNP is telling voters that none of the parties care about them, or that turnout is falling.
The structure and funding of local services should be modernised, but national standards and targets should remain, albeit fewer of them, he says. There should also be a moratorium on ring-fenced cash, and local authorities should 'increasingly focus on commissioning, not providing' ('steering, not rowing', as US reformers put it a decade ago).
A sinner repenting? Yes, though in fairness Mr Milburn did try when he was health secretary, grappling with his own interventionist nature. In the middle of all this, he admits that 'locally generated petitions or ballots' may still have to generate central intervention to rectify failure.
'Direct elections to some services should also be considered, ' including some places on school and police boards as well as primary care trusts, he says. Of course, Mr Milburn set up foundation trust elections, not for PCTs - they are only just starting up, he once explained.
A survey of wannabe foundations found that, alarmingly, few people have registered: 600 at University College London Hospitals trust, though 3,500 down the road at King's College Hospital trust, 801 in Doncaster, 2,000 at the Queen Vic in West Sussex, and so on.
UCLH's warning that 'an interest group or Trot element' may try to take over may reflect the fact their local Labour MP (one Francis Dobson) was warning against a BNP threat - as were others - during the foundation bill debates at Westminster.
John Reid is calm about this. Some trusts are quicker off the mark than others.
The regulator, Bill Moyes, is in place to make sure the 'patient cohorts' are representative, and when electronic patient records become a reality the voter rolls will be secure from Trots and BNP types.
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