Published: 13/05/2004, Volume II4, No. 5905 Page 19

Are there elections in the air?

There must be.Hence the spectacle of full-page Labour adverts in this week's newspapers, a spoof CV denouncing Michael Howard's record on crime, the poll tax and the minimum wage, as well as calling the NHS 'Stalinist'.

It is not the only sign of rising political blood pressure. I can confirm reports in the gossip columns that health secretary John Reid did indeed exchange harsh words over a posh curry with senior staff of London's Evening Standard.Contrary to reports, former health secretary Alan Milburn was not present at the occasion, but Mr Reid needed no help from him in explaining the errors of the paper's NHS persecution.

Mr Reid apparently protested that the anti-NHS bias of its editorial line stood in sharp contrast to the pro-NHS tone (even when reporting the same events) of its weekly jobs supplement, which carries£1m worth of health service ads each year.

For good measure, he addressed the editor as 'Vanessa' and 'Nessy'when her name is Veronica. By accident or design, I have not been able to establish.

Does all this matter on the wards? Well, yes. The Evening Standard is stablemate of the Daily Mail and increasingly influenced by it. The news agendas of Fleet Street - and the BBC - are, in turn, influenced by their local paper's seven daily editions.

But Ken Livingstone, the best-known candidate in next month's London mayoral election, has survived the paper's enmity for 25 years. So can the NHS, provided it delivers. In this context, NHS chief executive Sir Nigel Crisp's upbeat annual report on progress to meet targets - ahead of time even! - must surely help beleaguered ministers.

Up to a point, Lord Copper, as we used to say in Fleet Street.

When I recently lunched with Andrew Lansley, Tim Yeo's diligent deputy on the Conservative health bench, he was calmness itself about his conviction that voters will not believe Labour's claims when the real election comes next summer.

The patient passport is a scheme whose hour has come, he insists.

It is all to play for.

Two interesting points arise from Sir Neil's (as Mr Reid probably calls him) report.

One is left wing: if the service is doing so well on the back of the extra£5.9bn before most of the private sector contractors are up and running, who needs them?

Good question, and Mr Lansley's ambitions to make much more use of the private sector is part of the answer.

'If radiology is badly managed in the NHS, as it is in some places, why not contract it out?'

a senior minister told me recently. There is no doubt that prime minister Tony Blair himself thinks that way: the NHS should be much more of a 'commissioner' of services.

The other point is more overtly right wing: Sir Norbert told reporters that NHS staff are working harder (even Mr Yeo conceded that ahead of his visit to the Royal College of Nursing conference) when it would be better if they worked smarter. In other words, changing work practices is the key to higher productivity.

Ministers are poised to announce such changes:

pharmacists to be allowed to provide statins across the counter, for example. But It is the NHS's quiet IT revolution that is crucial here. The electronic patient records and other innovations will speed up appointment booking and improve the interface between primary and hospital care, officials predict.

Tucked away in all this is the private acknowledgement that one reason why voters remain wary of NHS performance (Labour pollsters confirm this), is not because of the medical care but because they wait so long to get it, being pushed around the system between GP and consultants before they receive it.

Diagnostic procedures such as radiology are part of the problem which ministers know they must hack away at if the dramatic fall in inpatient waiting times (they are expected to fall even faster now that the NHS is gathering speed) is not to be tainted in the eyes of voters who are - Mr Blair believes - in a 'what's in it for me?'mood over public services.

He wants to make them a 'personal offer' in his manifesto, part of a five-year programme that will also address chronic diseases.Mr Blair will face a mediaorchestrated wall of scepticism. Sir Nobby's annual report was reported in the Mail under the headline: 'So We are all wrong and the NHS is doing fine'. l