'Mr Blair retains a lot more drive and determination than Mr Major had (ever), but his authority is fading'
Fewer MPs than you might have expected turned up on either side of the Commons to complain when Patricia Hewitt announced the provisional figures for NHS trust losses in 2005-06 the other day. But they were pretty sceptical as to how accurate£1.3bn gross will prove to be. It was not the health secretary's only bruising encounter that had the potential to cause more trouble in the months ahead.
The source of my prediction is the NHS Redress Bill, which we last spotted battling its way through the House of Lords. Tory, Lib Dem and assorted crossbench peers joined forces to amend the government's plans to ensure that the proposed NHS Litigation Authority is not what successive lords and ladies called 'both judge and jury' in such cases.
Will ministers accept the crucial Lords amendment to allow independent investigation of the facts in a case under the aegis of the Healthcare Commission? Ms Hewitt and her new sidekick, Handy Andy Burnham, did not categorically rule it out in their speeches on the bill's second reading in the Commons. But they made plain their disdain for what she called an over-complex 'two-tier system' which would only delay their hopes for a speedy and effective remedy. It might also cost an extra£41m to run, ministers claim.
Alas, we have reached a stage in the life of the Blair government where ministerial plans do not automatically carry the authority they did, where experts can pick them apart as half-baked and MPs - Labour MPs among them - can vote to improve them. When Westminster chums say 'it's as bad as John Major', I argue that Mr Blair retains a lot more drive and determination than Mr Major had (ever), but his authority is fading.
So it was interesting to note that there was no vote for or against the bill's second reading (ie the vote on the core principle of redress, which everyone supports) as MPs told of sad constituency cases. But some Labour MPs endorsed doubts expressed by Mind, the Patients Association and others.
Such as Sion Simon, the clever, loyalist MP for Birmingham Erdington, who has been fighting off blindness for several years and revealed himself to be a trustee of patients' charity Action against Medical Accidents (AvMA).
Mr Simon endorsed the complaint of Conservative spokesman Andrew Lansley that ministers had drawn the bill too narrowly by ignoring many of the recommendations made in Making Amends, the investigation into the problem by Professor Sir Liam Donaldson, known to us all as Ms Hewitt's own chief medical officer.
Most conspicuous is the decision to retain what you may know as the Bolam test (from Bolam v Friern Hospital management committee in 1957) for establishing medical liability.
Basically Bolam means there was a breach in the NHS's duty of care and that it caused injury. It creates what the lawyers call a tort, an injury for which a civil action can be brought. Sir Liam wanted a broader definition in which remedial action, apology and explanation, and possibly modest cash compensation (the bill provides up to a£20,000 limit), should embrace cases where there has been no negligence.
The current system opens what I will not call the floodgate to complaints and litigation because, even in our increasingly litigation-minded culture, of the nearly 1 million NHS incidents and near misses which the National Audit Office detects, there were only 5,609 legal actions in 2004-05, slightly down on the previous year according to Lib Dem MP Sandra Gidley.
But most litigation is funded by legal aid, for which most of us are not eligible. Only a quarter of cases are won, one-third are abandoned, 43 per cent are settled out of court. It takes huge NHS time, costs£500m a year, disproportionately benefits lawyers and often disappoints litigants who started out just wanting a 'sorry' and assurance that Mum's fate would not befall anyone else.
Mr Lansley wants three things: an independent investigator, transparent proceedings and rapid redress of the grievance. What critics fear is that deficiencies in the government's fast-track 'alternative to litigation' will ensure that some cases still end up in court. Mr Simon says that NHS contract lawyers are often 'absolute rubbish' as well as being slow and expensive.
Michael White is an assistant editor (politics) of The Guardian.