Published: 19/09/2002, Volume II2, No. 5823 Page 19

Returning from an all too brief and damp expedition across the Channel, it is easy to imagine that the bulk of the government's and media's emotional energies have been absorbed by the prospect of a bloody showdown with Iraq.

Personally I remain sceptical about a war, despite having used my break to read (well, almost) Roy Jenkins'monumental biography of Winston Churchill, a man whose idea of recuperative healthcare seems to have been to work a bit harder and drink only weak scotch and soda for breakfast.

But as so often happens when one topic absorbs most attention (the dreadful murders in Soham were the summer's only other drama to rival the psycho-diplomatic skirmish), Iraq provided a breathing space for health ministers and frontline staff who might otherwise have been caught up in political football matches.

After all, both Churchill's world wars started in August, just as health ministers like Ken Clarke tend to get photographed ringing Richmond House from an EU pay phone.

Last August there were rows over trolley waits, overseas treatment of NHS patients (That is old hat by now! ) and that Libyan woman who had a multiple birth in Newcastle.

This year it hasn't happened, leaving the Milburn team all back at their desks after a relatively clear run. The health secretary himself has been juggling work with child care, feminists please note, while his partner gets on with her own NHS life.

Which is not to say that health policy has been entirely given over to an August trolley wait. Ministers are considering reclaiming the cost of accidents at work from careless employers (haven't we heard this before? ) and Iain Duncan Smith has promised to deploy tax breaks and insurance to prevent old people selling their homes to pay care bills (haven't we heard that too? ).

Frank Dobson has also savaged 'two tier' foundation hospitals (ditto).

Mr Milburn is back at his desk determined not to ease up on the pressure for reform and convinced that, as the extra billions find their way into the rivers and streams of the NHS, the service's managers and other staff are 'keen to do more' in terms of reforming work practices.

The system has to change in order to cope with the investment that is now coming in.

That is the way he's thinking, all too aware that if the government allows the Iraq crisis to take its eye off domestic reforms, voters will eventually punish it, war or no war.Winston Churchill learned that lesson at the 1945 election.

That is the political spur goading health ministers. They have to promote choice, or let Mr Duncan Smith proclaim that a public system can't deliver what voters want.

They also have to promote equality of access to better healthcare to prevent Gordon Brown (and Dobbo) protesting that the reforms bring even more inequality.

Alas, I cannot report that Mr Milburn and the chancellor have yet patched up their differences over the financial freedoms to be given to foundation hospitals. They did meet briefly at the 9/11 service at St Paul's Cathedral, but much detailed work still needs to be done.

I was struck reading Churchill by a paradox of powerful leadership which I would previously missed. Here was a man who interfered in everything.

'Action this day' was a familiar note on the top of his memos, often dictated at 3am. Yet he was confident enough to spend many weeks abroad - the US, north Africa, Russia - throughout the war, 172 days out of 365 in 1943 alone, plus 31 days of recuperation at Number 10 and Chequers, because he did collapse occasionally.

The key seems to be appointing the right people in the right structures, Alex and Monty in the desert, Ernie Bevin in charge of manpower, himself (naturally) as defence minister: strong direction from the centre, but strong managers in charge.

Churchill liked to dominate, but he liked to dominate only first-rate people, notes Mr Jenkins.

There may be a lesson there for NHS reformers and some comfort from last week's appointment of yet another NHS czar in the shape of Professor Sir George Alberti to shake up emergency admissions.

I am wary of the czar approach - too much of a media gimmick. But people of high repute with good informal networks may reach bits of the NHS that Richmond House can't.

Action This Day !