Published: 05/02/2004, Volume II4, No. 5891 Page 21

What does all the excitement generated by prime minister Tony Blair's tuition fees revolt, Lord Hutton's unexpected report and chancellor Gordon Brown's conspicuous muscle-flexing mean for the average NHS manager or hospital nurse, I wonder?

Health secretary John Reid is in no doubt. Touring the postHutton BBC studios at Number 10's behest to deploy his brand of genial menace against the routed broadcasters, his subtext message was: 'Tony has bounced back even stronger than expected and do not take the succession for granted anyway, Gordon.'

Incidentally, had defence secretary Geoff Hoon been forced to resign (he was braced for it) or is reshuffled soon, Mr Reid will not get his job, as he would once have loved to do.

That is over. He knows health is a much more important one (more than double the defence budget, too). He will be there until polling day at the earliest, he believes.

Myself, I am slightly less convinced than I was six months ago that Mr Blair will be the Labour prime minister who wins the next election. But I would still offer odds of 6/1 that he will be, unless the whole 'trust' thing gets much worse. If he has sense, he will plan to leave in 2006, or perhaps on his 10th anniversary, May 1 2007.

Michael Howard's misjudged performance after Lord Hutton's acquittal of No 10 reinforces my hunch. He has wisely tried to live down his old, mean reputation since becoming Conservative leader. But instead of admitting Lord Hutton had wrong-footed him he kept attacking. 'He's just an attack dog, ' Blair says privately.

Like his appeal for NHS workers to report waste in the public services - that full-page ad in The Guardian - it suggests Mr Howard really does believe New Labour is just a spin doctor's con.

It is not. Mr Howard should have read Mr Blair's public service speech in Rickmansworth the next day.

Although the Tories hit 40 per cent in one poll last month - for the first time in a decade - Mr Howard must be torn between wanting to keep a damaged Mr Blair in place and the prospect of having prime minister Brown to paint as an Old Labour, highspending, centralising socialist.

It should be important to nurses and harrassed NHS managers to know that he is not. That is the danger of the chancellor's impatience for his inheritance, those 'Real Labour' speeches he makes and the way his acolytes voted for tuition fees only at the last minute.

They give daft MPs - and Unison - the false hope that Mr Brown would be less of a moderniser than Mr Blair, when actually the austere Scot might actually be worse: his pressure on university managers to be more efficient points that way.

More serious, Mr Brown's equivocal rhetoric also gives an Old Labour impression to City fund managers who might get jittery and sell sterling at a volatile time.

Does that matter to NHS managers? Of course. It would help fuel higher interest rates and taxes, possibly inflation too (the way the US is heading) which would derail Mr Brown's huge public spending plans, as this column has long feared - wrongly so far.

The boffins at the Organisation for Economic Co-operation and Development are already telling Mr Brown to cut back on spending, raise taxes and impose charges on people using the NHS and other core public services.

This is the so-called 'co-payments' issue which Robin Cook (against) and Stephen Byers (for) raised on Sunday TV sofas.

It is a phoney debate. Even Mr Byers admits that he is only thinking about charges for expanded state childcare and motorway tolls, not for patients or pupils.

TB and GB (as officials call them in Hutton e-mails) agree. They want students to 'co-pay' directly for their higher education.

Tony may be naively optimistic over Iraq or NHS reform, but he is not a cynic. He believes what he says when he says it.

In Rickmansworth last week he said he would speed up, not slow down, the pace of reform and do so in the name of social justice.

Those who claim that foundation hospitals or top-up fees will create a two-tier system are denying that one already exists.

He talked a lot about what Labour had done for the NHS since 1997. Compare what happens to someone complaining to his GP of chest pains then and now, he boasted.

The way forward is through central cash, but local initiative and accountabilty. 'It is the staff who make the difference.' I hope he is right. He really does believe it.