Michael White: junior doctors

During political storms as heavy as this one, Labour health ministers could do worse than recall a line from Joseph Conrad's novel Typhoon that Michael Foot liked to quote during his own (many) times of trouble: 'Always facing it, that's the way to get through.'

Of course, Mr Foot did not get through. In 1983, Typhoon Maggie overwhelmed him. David Cameron is far from being a hurricane force yet, but if I were Patricia Hewitt I would have watched TV footage of the Tory leader being cheered by a large throng of angry junior doctors last weekend with some alarm.

Any such moment of introspection will have been enhanced by at least one Tory columnist urging Gordon Brown to demonstrate his new broom credentials when the big day comes by cancelling the NHS deficits and replacing Ms Hewitt with his own protege, Yvette Cooper, aka Mrs Ed Balls.

Likely? No, I don't know either. And Mr Cameron's own speech to the Tory spring conference contains its own vulnerabilities. It was a good speech and contained that damning soundbite about Labour 'ripping the heart out of the NHS and replacing it with a computer' (see below).

Not done on purpose, he hastily added, but because Labour is fundamentally pessimistic about human nature - 'it does not trust people and the NHS is all about people.' Grand stuff and Mr Cameron's proposal is to sweep away the management consultants, the 'vast inhumane machine, the pen pushers paradise' and decentralise power to, er... the NHS professions.

Is that the simple answer? I am not alone in doubting it. No wish to be difficult about this, heaven forbid in a week when so many critical reports have battered the good ship SS Hewitt. The King's Fund claimed that less than one-third of the extra£19bn put into the service since 2003 went directly on better services. Yes, it is an over-simplification but a damaging one.

Last week the Commons public accounts committee condemned the costly mishandling of the GPs out-of-hours coverage in the new contract. This week the PAC came back and took a look at NHS deficits. No one cause, conceded the chair, Tory ex-minister Edward Leigh.

He noted the burden of the additional£500m arising from those very generous, mishandled pay contracts, the persistence of deficits in the same trusts over the years, indicating weak financial control and what Mr Leigh calls 'a lack of interest by clinicians in financial matters' (I don't think he means their pay).

In calling for greater transparency in future, the MP adds that there is 'no excuse for clinicians to distance themselves' from grubby budgets either. Judging from recent remarks, I suspect that Andrew Lansley knows that. This week he revived a German general's jibe from 1914 about the British army (NHS staff are 'lions led by donkeys') and suggested that the secretary of state should become the public health secretary to reflect new priorities.

But does General Lansley tell Field Marshall Dave that putting medics in charge again may not do the big trick? The fictional Sir Lancelot Spratt may have become a matier Lance Spratt on the wards these days, but Lance still represents consultant power.

What does the government do in the face of a Joseph Conrad medical typhoon? It battens down the hatches and puts Ms Hewitt up for interview. On air she recalls that Tory spending plans (as reinterpreted by Labour apparatchiks) would cut£28bn from NHS spending and that Dave and his mates all voted against the extra billions which Tony and Gordon have directed the service's way. It is all she can do until the budget storm eases.

Mr Blair, meanwhile, makes fresh 'offers' to voters. More and earlier choice in hospital options, more walk-in centres and other help to under-doctored areas, and a headline-grabbing option to let Tesco, Boots and even Virgin run GP surgeries where they are needed.

Are voters still listening? I'm all for piloting ideas. Labour policy-making has not always been sufficiently evidence-based since 1997. There is a frantic quality to Captain Blair's dash for the home port. Lashed to the mast, facing the typhoon, he may be. But the Cornish coast is full of wrecks.

Michael White is an assistant editor (politics) of The Guardian.