Published: 17/11/2005 Volume 115 No. 5982 Page 10

Spare a thought as autumn finally turns into winter for our old friend, John Hutton, newly promoted from eternal No 2 at health to fill David Blunkett's shoes as secretary of state for work and pensions; what we used to call social security.

Quietly competent and not selfpromoting in the publicity stakes, Mr Hutton was always going to be the sort of MP Tony Blair would promote if the opportunity arose. He was never going to make a 'give me a cabinet job or I quit' sort of demand which has left the excellent Nick Raynsford and John Denham on the backbenches.

I was discussing their case the other day (disgruntled ex-ministers often end up as rebels) in the wake of Mr Blair's defeat on the terrorism bill with an MP chum who said 'Tony never promotes anyone over 50'.

That is not quite true, and the respected Margaret Beckett - who first became a minister in 1976 - will be 63 in January. John Prescott is 67. But I acknowledged the point when my friend said 'Hutton got in under the wire'. Sure enough, Mr Hutton entered the cabinet on May 6 this year, his 50th birthday and Mr Blair's 52nd.

It now looks as if Mr Hutton may backtrack on the timetable for housing and incapacity benefit reform in a tactical retreat in the face of backbench Labour anger while he masters his brief. Will Patricia Hewitt, Mr Blair's fourth health secretary since 1997, have to do the same?

That is certainly the new flavour of mainstream media analysis, in so far as there is any, though Ms Hewitt's major NHS pronouncements seem to get less and less coverage in several major newspapers now.

Last week she apologised over the primary care trust fiasco in July and said she would also be less 'prescriptive' over the private sector's expanding role in commissioning. She will be listening more attentively to backbench MPs ahead of the January white paper on care outside hospitals.

But that does not mean ministers will back down on their strategy of choice and competition as the best way of ensuring the 10 per cent of national income Britain will soon be spending on healthcare - up to the EU average at last - is spent as effectively as our neighbours spend it.

Ms Hewitt's speech to the New Health Network on November 7 (worth finding on the Department of Health website) was peppered with complaints ordinary voters had made about the shortcomings of services; one damning account by a senior NHS manager who could not get basic courtesies on the ward for her dying husband.

As a reality check I spoke at the weekend to a Labour ex-minister of working class stock, who remains a loyalist. As a former area health authority member in his pre-MP days, he keeps a firm eye on the NHS in his inner-city constituency and looks with disdain at what he regards as the posturing of middle class colleagues who rebel.

'Some people on my side get the vapours when they hear about anything that smacks of privatisation, though when you ask them when exactly the NHS was in its heyday, doing the job it is supposed to do, they get a bit vague, ' he barked down the phone while feeding the cat on Sunday night.

The MP's bile is also directed at constant NHS restructuring. 'My constituents do not give a toss about co-terminosity' But his real anger turns out to be against what he regards as the 'stranglehold by the doctors, the royal colleges, the British Medical Association and the General Medical Council' over the medical profession, designed he says to perpetuate shortages that will maintain the salary levels and status of 'one of the most socially exclusive professions'.

It follows that the new GP and consultant contracts were too generous, so he is right behind Ms Hewitt's demand for GPs to try a bit harder to keep their surgeries open longer. 'It is the middle classes practising their craft over the working classes. Break the doctors' grip over the performance of the NHS and you will get value for money, ' the MP told me.

I am not suggesting his analysis is typical, let alone correct. But It is there. And he did chuckle over the BMA's outraged response to new prescribing powers for nurses: bad for the medics' closed shop.

Michael White is political editor of The Guardian .