NEWS

Wow! That was quite an alarming week one way or another. Do I refer to those media tales about hordes of German GPs flying across the Channel to boost NHS cover? What a puzzle our parents and grandparents would have made of the new Europe in action!

No. Or to the latest alarming stories about the dangers of red meat (bowel cancer), that 80-week wait for an MRI brain scan ('but here's the phone number if you want to go private'), or the new 'hospital superbug blitz' which is now such a media cliché?

No. We will even ignore the farmers' call for a ban on the phrase 'couch potato' which they claim is negative and damages spud sales.

Which I doubt.

For me the wow factor lay in Patricia Hewitt's charm offensive at the NHS Confederation's conference, magnificently spearheaded in last week's HSJ interview with its world exclusive on the health secretary's amazing typing speed.

I wasn't in Birmingham, but I know Ms Hewitt's silky tone well enough. Unlike her predecessor, John Reid, who did his own menacing (but not his own typing), she belongs to a different school: 'I abhor violence, but my associate, Bruiser Crisp, has no such scruples.' The Hewitt sting lay in the tail, that widely reported reference to 'the pot of gold potentially in your grasp' in the shape of those extra BlairBrown billions which leaves hospital managers with no financial excuse for not ramping up productivity.

To make her point painfully clear she cited the case of seven London hospitals where hip fractures command an average hospital stay of anything from 20 to 38 days, when the overall NHS average is 25. Faster, better, cheaper - That is all she wants.

It reminded me of what former health secretary Frank Dobson used to say.

'If the average NHS hospital was as good as the best we'd have no problem.' And you probably remember where Dobbo stands on the government's patient choice agenda, which Ms Hewitt fully endorsed: he thinks It is a Blairite gimmick that will end in tears.

He is not alone in that respect, as we all know. The confed's official response to Ms Hewitt's first big speech was to take the challenge on the chin and say 'yes please'. That is smart politics. And I notice that Professor Donna Shalala, Bill Clinton's health secretary, told the conference that 'patients in the driving seat' is the only way forward.

But when I rang Steve Webb, the Lib Dems' new health spokesman, he was full of foreboding about the speech. 'We all know the [financial] brakes are going on in 2008. If progress has been contingent on more money, ministers are already saying the NHS must now squeeze more out of what they have.

The battle for three years down the road is being fought now.' The MP for Northavon, Bristol, is an economist by training - and it shows. He looks at his own local hospital network, dominated by Frenchay, Southmead and the Royal Infirmary, and sees them, all high-cost specialist trusts, struggling with their budgets.

In theory the Hewitt model, though careful to stress the need for a 'sensitively managed market', could see failing hospitals go under, he contends. Would any government dare to let much-loved institutions go to the wall, a prospect raised by senior Whitehall officials at the confed's conference?

How does that prospect incentivise staff, Mr Webb wonders. It may work on senior managers who can be replaced for failure or richly rewarded for success, but not for the thousands who work below them.

And what if the pushy middleclass all crowd into one hospital, leaving its 'half-dead' rival to go quietly pear-shaped? So much for the benefits of patient power and choice, he muses.

Mr Webb, the self-styled leftie economist, concedes that unsuccessful baked bean providers go out of business as part of the logic which drives market efficiency.

But Labour's drive to create competition in the system also means that it seems to be deploying block contracts to protect private providers entering the NHS.

As 'infant industries' - in economist-speak - they need time to build up some fat. 'What an irony, ' he observes. 'I instinctively feel the market mechanism is not the way forward. But I do not yet have the answer.' .

Michael White is political editor of The Guardian.