Published: 18/04/2002, Volume II2, No. 5801 Page 21

There was a brief phase during last week's pre-Budget excitement when I felt sorry for Dr Liam Fox, the Conservatives' irrepressible health spokesman. It came after seeing his private NHS briefing spread all over the Daily Mirror as 'Dr Death's secret plot'.

The phase did not last for two reasons. One was that Dr Death has been caught out by the Daily Mirror on a previous occasion and should have known better, the other being that I was too busy feeling sorry for Alan Milburn.

My Milburn sorrow phase was of short duration too, as it became clearer by the hour that Gordon Brown's budget would be bequeathing the health secretary ever larger sums from his fine old collection of bank notes. In advance of this, Mr Milburn, Miser Brown and Tony Blair himself all went public to say that a taxpayer-funded NHS is the only way forward.

'We have pretended for far too long that we can get world-class health on the cheap. That pretence can no longer continue, ' said Mr Milburn as he introduced chief executive Nigel Crisp's report on progress with those tiresome waiting lists - the report itself a mixed picture.

More serious for the secretary of state, of course, was the King's Fund report complaining that the NHS is being overwhelmed by what the fund's Julia Neuberger called 'well-meaning policy directives, must-do targets and structural changes'. Health managers do not need me to say she has an important point.

This is where the latest Tory offensive seeks to exploit a weakness. On Monday, Tory leader Iain Duncan Smith launched Alternative Prescriptions, a thorough piece of comparative research into 20 top healthcare systems - from tiny New Zealand and Belgium to the rich, unjust US system - which not even IDS wants to touch with Dr Fox's bargepole.

Much of its contents will be familiar to HSJ readers. The US comes top for responsiveness to patient need, 19th out of 20 for financial fairness. No surprise there. But the NHS is only 7th for fairness and 16th for patient dissatisfaction (Austria comes top, Italy bottom).

The most wounding line of attack is that Mr Brown's native Scotland - which already has 8.1 per cent of GDP spent on health, close to the EU average (England is still on 6.3 per cent)and better staff ratios - still has many worse health outcomes.

Something wrong with the way the money is spent? That is precisely Duncan Smith and Dr Death's point.

Duncan Smith aides stress that the boss wants more money spent on healthcare and that the system should still be based on need, not ability to pay. They compare the NHS with the centralised systems now being abandoned in ex-communist Eastern Europe, not quite as bad as my old chum, Melanie Phillips, calling the system 'Stalinist' in the Daily Mirror. I have e-mailed Mel to complain.

Back to Dr Death aka Fox.What he actually said to the Conservative Medical Society's fringe meeting at the Tory spring conference in Harrogate (cunningly taped by a Labour mole and given to the pre-budget Daily Mirror) was not very different from what he said publicly at the same conference.

'Labour's response is to pour in more taxpayer's money and tinker at the edges of the NHS. Sadly, they will not succeed.The NHS is a collectivist model in a consumerist world, ' he said then. And: 'The public have instinctively trusted Labour on health, but their hopes are being shattered, ' etc etc.

At the CMS, Dr Fox - who like another animal, AA Milne's Tigger, is prone to over-confidence - merely spelt out his four-point plan: persuade voters the NHS is not working; convince them it can't be fixed; show how we can learn from other systems, notably the EU's compulsory social insurance models; and finally to set out a Duncan Smith cabinet that would break the 1948 mould by offering diversity of funding streams and medical services.

My Labour chums were outraged, correctly claiming it proves the Tories want to dismantle the NHS. An old charge which has often worked for Labour. But will it work again if the Brown billions do not deliver rapid improvements?

That is the£5bn question as voters square up to higher taxes.

What a pity that 'Death to the Fox' is a politically incorrect Labour slogan.