Published: 15/12/2005 Volume 115 No. 5986 Page 10

I expect Patricia Hewitt and the Department of Health will be all too glad for a few days break over Christmas. Just when you think the crisis headlines can't get any more alarmist, up pops smoking again. Or Herceptin. Or obese people being denied instant treatment.

Or NHS deficits, of course. They had Ms Hewitt on Radio 4's Today at dawn on Monday, having to deny claims that the cumulative deficit will be£7bn by 2010. So says the rightish pressure group, Reform, which wants a real market in healthcare. So take it with a pinch of mincemeat.

Let us search instead for a little festive uplift in all the gloom; the health manager's equivalent of O Come All Ye Faithful, which always cheers me the first time I hear it in December, year after year.

I think I spotted a ray of sunshine reading another of those localhospital-under-threat debates that we regularly get at Westminster.

This one was in Altrincham on the Cheshire plain, where the energetic Tory MP Graham Brady was doing what MPs do: riding a tide of constituency anger.

What got the locals 'not mildly irritated, but furious', the MP explained, was that letters confirming Altrincham General's future were being issued as late as July. But when the deficit deluge struck in November, Trafford South primary care trust adopted closure as a possible option.

Mr Brady called it ' a knee-jerk panic response' over a hospital which has step-down beds, a minor injuries unit (11,000 customers a year) and 20,000 tests in its clinics.

It had been earmarked for a capital upgrade.

Hang on, though. Altrincham General was built in 1870. And the fundamental question posed by Liam Byrne, the junior minister who will not stay junior very long, was that, if the£36m of extra funding due to the PCT is to be invested wisely, should it be spent upgrading a Victorian hospital, however much loved?

'The debate is not about the past, it is about the future, ' said Mr Byrne, as David Cameron said last week to Tony Blair. While on the subject of the new Tory leader, Mr C delighted Andrew Lansley by keeping him in post as shadow health secretary, instead of moving him (as feared) to Ms Hewitt's old trade job.

'Andrew really enjoys it and he knows the brief. In fact he's effectively been health secretary for the past six months because Patricia Hewitt can't do the job, ' says an over-zealous Lansley partisan.

What cheery Mr Byrne was trying to persuade Mr Brady to accept is that Altrincham faces 'fantastic choice' about what to do with its extra cash, not gloom. 'We are happy to write a big cheque, but not a blank cheque.' Rarely has the reformers' case been stated so simply.

What this translates as are options like beefed-up practicebased care which would fill a hospital's role locally while leaving the fancy stuff to, in this case, Trafford General up the road. Mr Brady accepts the point. How about using it as a breast care unit? he asks. Nothing is finalised, Mr Byrne assures him.

Overshadowing this is the weekend report in The Observer, which may have muddled the endof-year row over local deficits and cuts with a technical row in Whitehall. It saw a leaked DoH memo telling central staff not to commission any new public health programmes against alcohol or fags - or else. Mr Lansley fanned the flames of outrage at 'broken ministerial pledges.' What this is really about, so I gather, is a battle between the DoH and the Treasury over the definition of certain programmes: do they count as 'cash' and are they thus counted towards Gordon Brown's precious 'golden rule' on spending commitments which is currently under pressure, as last week's prebudget report confirmed.

Or are they 'near-cash' - what accountants call contingent liabilities - and not real money?

Until It is sorted, decisions will be restricted. Not your problem, so pour another small sherry.

Like Mr Byrne, PM-in-waiting Brown is looking towards the next election and getting problems fixed in plenty of time. Thus the chance for Altrincham folk to think creatively about historic problems is now, when the extra cash is still flowing. .

Michael White is political editor of The Guardian.