opinion POLITICS

Published: 16/01/2003, Volume II3, No. 5838 Page 21

It may have been a bit of post Christmas gloom, but 24 hours after the Labour revolt in the Commons over foundation hospitals a former minister was berating me over Tony Blair's failure to listen.

Mr Blair had toured the tearoom after PM's questions, but unlike Jim Callaghan, Labour's last prime minister, whose problems were somewhat greater, he doesn't do it often and doesn't make backbenchers feel sorry for him, as Jim did.

'Tony doesn't have a lot of favours to call in, ' my friend snapped as he linked the foundation hospital issue with top-up fees for higher education, with the tax-and-spend shortfalls which loom for the Treasury and, of course, with the prospect of war with Iraq.

All these controversies remain uncertain. But the hospitals row is now tangible to the extent that at least 109 Labour MPs have signed a critical Commons motion and 25 of them remained ostentatiously on their green leather benches rather than back health secretary Alan Milburn at the end of the debate.

Thus Dr Liam Fox's Tory motion, mischievously praising foundation hospitals 'as a means of improving and enhancing patient care' (he wants lots more! ), was defeated by 381 to 144 votes, but Mr Milburn's amendment was carried by only 282 to 150.

Somewhere, 100 votes went walkabout (or sit-on-bumabout) in the space of 20 minutes.

No rushing for the last bus, either.

NHS connoisseurs of shift work might care to note that, under the new sittings regime, this debate started at 12.38pm and voting finished at 7.27pm.

As with Iraq, the vote does not mean ministers cannot carry the day in the Commons (the halfreformed Lords is always unpredictable), but it does make the forthcoming more vulnerable to attack - amendment, even - from left and right.

In effect, a new policy which was already the object of uncertainty to NHS managers who might fancy a try at foundation status will become the source of greater uncertainty in the months ahead.

There will be plenty of other uncertainties around too. We are not yet back in Jim Callaghan's world, but after years of gravitydefying stability normal government is gradually returning.

The Number 10 delivery unIt is half-leaked report in the Financial Times that very morning raises the stakes still further.

The Milburn camp was unphased by the leak, and to say there are 'immense risks' in the pace of current reform is a statement of the blindingly obvious.

But the leaking of Michael Barber's remarks suggest - at least to me - that someone wants to increase the pressure on Mr Milburn, as he is doing to so many others.

So what came out of the debate, apart from low party politicking?

Dr Fox asked some good detailed questions about how the new hospitals will work (Hansard, January 8, column 182) which he said Mr Milburn had ducked.

The health secretary made his now-familiar case for diversity of provision and local control, though Labour MPs gave him a hard time over both. It did not help that the likes of Stephen Dorrell, who once sat in his seat, praised Mr Milburn as a 'turncoat' who had - rightly - changed sides.

'Commissioning and the provision of access is the key [to a better NHS], not the management of hospitals, ' said Mr Dorrell, a sentence managers may want to cut out and keep.

Former health secretary Frank Dobson made a speech that was both moving and angry, urging young Milburn to abandon yet another structural change - one which will only benefit the strong, he insists - and concentrate on what matters in the long term: better handling of out-patients, less paperwork, less cross-infection, fewer assaults on staff and a better IT system.

David Hinchliffe joined him in condemning the 'two-tier' approach. Dr Richard Taylor, the famous NHS independent MP from Wyre Forest, was also sceptical. Yet former Welsh health minister Jon Owen Jones made a telling point the other way: the toilets in his local school are immaculate; in his hospital they are not. Perhaps local management of schools could work for the NHS too, he suggested.

Winding up the debate, gentle John Hutton, Mr Milburn's deputy and weekday flatmate, noted that some MPs wanted no such new status, others wanted it for all NHS hospitals, a third group wanted far wider freedoms than ministers are willing to concede.

Most damning of all was the speech that was not made. The previous day, Julia Drown, an ex NHS manager, now MP for South Swindon, had asked: 'Is there a secret 'change sake's unit' in the Department of Health which cares more about structures than patient care and wants to keep management consultants off the dole?'