Published: 24/04/2003, Volume II3, No. 5825 Page 17

The brilliant spring weather may not have lasted quite as well during Easter as holidaymakers might have hoped. But the Milburn ministerial team has been taking its break in good heart.

Why so? Partly because Tony Blair, patron saint of NHS reform, has survived the Iraq war politically and is getting on better with his old friend-and-rival at Number 11. If anything can unite Blair and Brown, it is the sight of Robin Cook misbehaving.

Unity is usually good for governments. But there is other cause for Milburnian comfort.

Not only did Unison vote at its Easter conference to co-operate with pilot schemes under Agenda for Change, but nurses and midwives have voted even more convincingly for the package.

Ministers have also sorted out that damaging claim by GPs that many of them would be worse off under the pay reforms. The terms of the Maunday Thursday agreement with the British Medical Association's GP committee should ease that fear. Even the consultants are edging towards the 'constructive incentives' formula for locally tweaked pay.

'Acceptance of all this means that large chunks of NHS staff are agreeing to roll with reform. There is growing acceptance of what we have been saying, that the more you do the more you get, and that investment and reform go together.We mean it, ' says My Man at the Milburn Elbow.

But what about the growing cacophony of complaint (The Economist was at it the other day) that most of the Brown/Blair billions are being eaten up by pay with no significant growth in NHS output?

Ministers insist that measurements of output have not adapted to new realities.

In any case, says My Man, 'the health service is based on two things, people and prescriptions'. Up to 50,000 extra staff cost money. So do drugs. Their price is not rising; it is the volume being prescribed. Listen to what voters say, not the moaning BMA whose leaders admit things are getting better, says My Man - but only do so in private.

But what is this ? A black cloud on the holiday horizon, threatening a downpour on minister Milburn's seaside sandcastle - an elaborate foundation hospital complete with moat, turrets and under autonomous baronial management. It is the latest report of the Commons public accounts committee which has dared to question NHS readiness to deal with emergencies.

Labour MPs mistrust the committee, partly because it has such large resources of its own - 750 staff under Sir John Bourn - to make it an independent power.

Its chair is always an Opposition MP (Harold Wilson before he became PM in 1964), currently the Thatcherite Tory ex-minister Edward Leigh.That makes them even more mistrustful.

As the news-dominating war receded, Mr Leigh skillfully obtained some welcome postwar publicity, largely by recycling Sir John Bourn's 2002 report, Facing the Challenge.It showed, incidentally, that the NHS activated its 'major incident plans' 118 times in 2000, 86 times in the eight months up to 9/11, among them eight major fires in the South East, five chemical accidents in the North West, two riots and three trains stuck in tunnels in London - because we are not talking terrorism all the time here.

Unsurprisingly, the committee - like Sir John - wants more emergency training, regular testing of procedures, stronger inter-agency co-operation (emergency services discovered poor communication systems in New York after 9/11 - We are talking compatible radios here) and other sensible improvements.

Skilled media handling is important in a crisis too, as the coalition forces in Iraq have shown, though not every day.

Health department officials mildly rejected Mr Leigh's complaints as out of date.The NHS has been training furiously and stockpiling equipment and supplies all over the place, in case Osama bin Laden or the possibly-late Saddam Hussein decide to call, they said.Things are much better, even outside pampered London.

My Man at the Milburn Elbow is less mellow. 'Of course we are better prepared.

But you do not tell everyone in every part of the NHS what you are doing for obvious reasons. If you say, 'in the event of an emergency we do X, Y and Z' in public, all a terrorist organisation has to do is take out Y.We learned that dealing with the IRA, ' he snaps. So there.