Published: 30/05/2002, Volume II2, No. 5807 Page 21

I am beginning to think the NHS is a bit like Stephen Byers. Whatever it does is wrong and certain to be picked on by its evercircling enemies - left, right and media.

When my own newspaper recently produced a 'Health crisis as people live longer' headline, a Whitehall health buff gently chided me: 'It shows we just can't win.'

At least Alan Milburn can take comfort from the knowledge that, as long as his chum, the transport secretary, is Fleet Street's favourite dart board, the attacks will not be personal to him. Not yet anyway, though on Saturday The Times printed a very unkind photo from his Harrogate speech.

A case in point was last week's unsurprising announcement on managerial freedom for foundation hospitals, reinforced for slow learners by Mr Milburn's signal that private health firms - foreign ones at that - will soon become a permanent (or do we spell that Permanente as in Kaiser? ) feature of NHS provision. The unions expressed alarm. Gill Morgan, chief executive of the NHS Confederation, called it the right diagnosis, but the wrong remedy: all hospitals needed greater freedoms, especially the poor ones.

The British Medical Association helpfully chipped in with a warning about 'two-tier hospitals'. As if they didn't already exist.

By the weekend even Frank Dobson, whose discretion is usually a model of gallant loyalty to ex-colleagues, broke his silence to warn against a renewal of damaging competition between hospitals and the prospect that foundation hospital asset sales will only increase inequalities because surplus land is simply worth more in the rich South East.

Dobbo wants innovation, not diversion and dissipation of effort. The arresting phrase he used on Radio 4's Week in Westminster invoked an NHS busy 'hiring management consultants, lawyers and accountants - all the uncaring professions'.

Ah, uncaring professions! As a journalist working among politicians, I naturally find it a wounding phrase. So must Norman Blackwell, former head of the Number 10 policy unit under John Major, who shared the microphone with Dobbo.Why? Because he is by trade a management consultant, a product of the cult global firm of McKinsey.

Lord Blackwell was on the radar screen because he had co-authored a pamphlet with Danny Kruger, a bright young Oxbridge pointy head (Better Healthcare for All, Centre for Policy Studies), extending Liam Fox's notion that the NHS is unworkable because - says Lord Norm - it is crippled by a 'triple nationalisation', funding, provision and purchasing.

The authors welcome Mr Milburn's move to liberalise provision of healthcare, including last week's foundation hospitals, but say it will not work as long as such hospitals still only have one customer: the state. 'While all the money in the system still flows downwards, accountability will still flow upwards - to Whitehall.'

Their wounding charge (how Nye Bevan would spin in his grave) is that the 1948 settlement serves those in most need - the old and the poor - worst and allows the sharpelbowed middle class to manipulate the system and drop out of it when convenient.

From our different standpoints, I guess you and I can both recognise that description.

Whether Lord Blackwell's remedy is right is, like all else, debatable. He wants to create community mutual insurers, which I take to be like American health-maintenance organisations, member-owned non-profits, which would buy healthcare using individual health credits we get from the government.

Regular readers will know I am a knowledgeable sceptic about US systems and was glad to read that Clive Smee, the Department of Health's chief economist, is challenging claims made that Kaiser Permanente offers its Californian patients more for less than the NHS - though Mr Milburn still plans to seek its help next month.

But I promised to mention innovation. It seems that Lord Sainsbury, the mega-grocerturned-science-minister (a Byers-like target of the tabloids for promoting GM crops) is setting up a taskforce to see how the NHS and its many in-house entrepreneurs can exploit their good ideas. He is being encouraged by venture capitalists like Sir Christopher Evans, himself a bio-tech man.

Splendid, splendid, though every schoolboy knows that ideas discovered in the firm's time belong to the firm unless you can show you did it on your day off. I hear the sound of the uncaring professions slamming the brakes on their BMWs and offering to litigate. And Dobbo gnashing his teeth. l