Published: 13/12/2001, Volume III, No. 5785 Page 21
I am not saying it was more than a coincidence.
But at about the time last week's HSJ turned up in your in-tray, containing a heartfelt editorial plea for ministers to stand up for the NHS, Tony Blair popped up for a 6 o'clock press conference at Number 10 - Alan Milburn at his side - to do just that.
In a welter of laudatory comment, Mr Blair said: 'I refuse to join the band of cynics who have it in for the NHS. I am optimistic about the health service. I have confidence in the NHS plan. I have faith in the NHS staff.'
This unusual event took place at the end of a week in which Mr Blair and his stubborn chancellor, Iron Gordon, had made what many of us felt was a poor fist of launching the 'big debate' on NHS funding. I imagine the PM must have felt so too, since he took time out from another very busy day.
In distant Afghanistan, Kandahar was about to fall. Indeed the funniest moment of the press conference came when not only did Sky's Adam Boulton ask about the war, but Nick Timmins, bearded social policy guru of the FT, did the same. 'You are the one person in the entire press conference that I pointed to in the absolute certainty that you would ask me about the NHS, ' an exasperated Mr Blair retorted, though in good humour. Mr Milburn also seemed at ease. They made a nice, wholesome New Labour couple - even about the same height, I noted.
What pleased me about the event was that Mr Blair - unlike Gordon Brown - actually took on EU and French health finance models and said how much they cost - a lot. 'There is no free lunch, ' he kept reminding voters.
That is important. Iain Duncan Smith spent a day in Sweden - like Britain, a state where 83 per cent of health spending is public. He came home rather more starry-eyed than a day-tripper wisely should. But the Swedes do seem to have decentralised management.
At least there is now the semblance of a debate emerging. The Sunday Times highlighted claims by the Civitas think-tank (never trust an outfit with a Latin name) that every household in Britain already pays£207 a month towards the NHS - 'similar to the [cost] of taking out private medical insurance'.
Reading that sort of simplistic and dishonest rubbish makes me feel like an anti-Taliban militiaman who has just spotted an unusually tall horse near To r a Bora and is reaching for his Kalashnikov. The whole point about funding the NHS from general taxation is that it is a progressive form of tax - the poor pay less, the editor of the Sunday Times pays lots more.Hurrah!
The King's Fund this week went off in the opposite direction, claiming that to meet the EU's average health spend by 2005-06 will take 10 per cent of GDP (not 8 per cent, as ministers claim) and an extra£45bn - 15p on basic rates of tax. I suspect that exact number-crunching is a waste of energy at this stage.
When I quipped that that extra cash in the NHS plan is guaranteed to push up the EU average, Mr Blair (no mathematician) looked perplexed: 'I do not think our economy is that large in relation to the whole of Europe.'
What struck me most from the Blair/Milburn show was the persistent assertion that the NHS's biggest problem - you knew this - is lack of capacity, which translates as lack of money for skilled staff and equipment. Better organisation and performance are also important, but in the end It is going to be about cash.
Mr Blair ducked my other question too. Social insurance, usually paid by employers and their staff, may not be fairer or more efficient than the British way - general taxation - as Derek Wanless said. But has it acted as a form of hypothecation which works politically, by giving Euro-politicians the electoral support needed to raise more money?
If so, the case that ministers must make against it is not a health case, but a jobs case. It costs£147 to employ someone on a£100 salary in France, only£117 in the UK. The difference lies in non-wage labour costs; hence, higher French unemployment. But at least the debate has started. A better week. l
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