POLITICS

I don't know how much you understand the mechanics of what has been going on in government these past few days. I don't mean the leaks of overexcited memos from the keyboard of Labour pollster Philip Gould, which I take to be the result of theft, not of inter-ministerial feuding.

What I do mean is the drip drip of details of the NHS national plan in the run-up to Tony Blair's announcement. In his£43bn comprehensive spending review, Gordon Brown confined himself to a few gruff remarks and telephone book numbers.

It's not that the chancellor is above upstaging Mr Blair. He did so on the day of the PM's Downing Street conference by letting fresh details of the comprehensive spending review slip out. But this time he knew that the boss would be giving the official details when he got back from the Okinawa economic summit, the one which cost£500m to stage - enough to build a hospital, as they probably say in Okinawa.

In the interval we had what looked like an authorised leak in The Observer ('you leak, but I brief ', as Jim Callaghan once tartly observed) signalling the creation of a 'patient's champion' in every hospital, to raise standards and morale on the ward. As you now know, it is part of a plan to make the service patient-centred.

Would it be cynical to note what a convenient coincidence it was that the Virgin report on NHS management and customer care seeped into the papers just 24 hours earlier? The consultants from Richard Branson's team went beyond their brief about courtesy, cleanliness and food, and accused senior managers of sitting in large offices (the BUPA hospital boss's was the smallest they visited) while staff morale plunged.

Though I cannot be certain (not being the recipient of the leak) I think it would be cynical. The trouble with partial leaking of speeches and policies to generate friendly headlines in advance - which is what often happens - is that they foster a climate of cynicism which can only be bad for politics in general.

It was terribly convenient, all the same, for a secretary of state bent on achieving results through a series of performance-driven public service agreements (PSAs) which are crucial to Mr Brown's largesse: 'cash in return for performance'. When Mr Brown unveiled his first CSR in 1998, the 600 PSAs were announced five months later. Chastened by their disappointing results, there are only 200 - hopefully more realistic this time - announced on the day.

The chancellor was trying to avoid charges of overspin (in a verbal slip which thrilled the parliamentary columnists he said he wanted to 'underspin the strength of our public finance' instead of underpin).No triple counting.Within days he was accused by the Daily Telegraph of understating his bonanza to calm the City, and of exaggerating the sum involved by its Sunday sister paper.£43bn?

£50bn?£100bn on by 2003-04. It's still a gamble on continued economic growth.

My advice as you study Mr Blair's statement this weekend is to be wary, but to give it a fair run. Monday morning's Fleet Street leak, clearly orchestrated with Alastair Campbell's blessing, was the one guaranteeing that, within two years, cancelled NHS ops will be done within 28 days. No ifs or buts: done in the private sector, if necessary. My mouth fell open, since the implications, medical and managerial, are profound. READ THE SMALL PRINT!

Here is a footnote to last week's fascinating HSJ cover story about people seeking healthcare abroad.

Yes, I keep hearing of people using E111 and E112 forms to go to France or Belgium. So I, too, assume the loophole will soon be shut.

Twenty years ago my late aunt despaired of getting her cataracts fixed on the NHS and got them done in Canada where she had lived for many years. The Canadian doctor (a friend of gynaecologist Richard Neale perhaps? ) botched it and the NHS resented picking up the consequences.

That said, I was horrified to hear Stoke-on-Trent South's Labour MP, George Stevenson, complain in the Commons about a constituent with hepatitis B who is able to arrange to get his thrice-weekly haemodialysis when he goes on holiday to Malta or Majorca. But he can't get it holidaying on the south coast of England.

Shortages, you see. Over to you, Mr Milburn.