'Voters are losing patience with Labour's performance - and its excuses'

What does this week's flurry over a clutch of bankrupt NHS hospitals and revised accounting rules from Patricia Hewitt at the Department of Health have to do with Gordon Brown's last pre-budget report in the previous week?

On the face of it, not much. The NHS was conspicuous by its absence from the chancellor's annual financial statement, life in the service all too fraught to warrant the upbeat generalisations that Mr Brown so loves on these occasions.

But parallel thoughts emerged as I grappled with the two events and with the latest policy battleground on which the Conservative front bench chose to fight in the Commons ñ °µblic health failures as varied as teenage obesity, smoking rates and sexually transmitted diseases (STDs).

One thought was that New Labour ñ ¡³ much as Old Labour ñ ²¥tains a belief that money spent by the state on school or hospital buildings or on campaigns can achieve more than it actually can. Second, Labour places excessive faith in the power of education and exhortation.

Thus, spanking new city academies will motivate children to learn, just as earnest campaigns about liver damage will stop young people binge drinking on a Friday night. This mechanistic approach can help ñ ¯¦ course it can.

But family cohesion, social discipline, self-respect and the like matter more. While the better off get better off, the weak and vulnerable are just that ñ ¡® underclass, frightened, feckless or feral. Iain Duncan Smith's interim report this week is surely right in that respect.

What is more, polls confirm, voters are losing patience with Labour's performance ñ ¡®d its excuses. When MPs debated public health, Labour MPs again trotted out the Thatcher government's suppression of the Black report on health inequalities ñ ·¨ich was over 20 years ago. It's just not good enough, folks.

I should not exaggerate. In her bright yellow jacket, Caroline Flint, the duty health minister, had plenty of successes to recall since 1979, although she did so with unseasonal aggression. And thoughtful MPs like Rotherham's Kevin Barron, chair of the Commons health select committee (wearing a grey suit, since you ask), acknowledged the role that private firms like Weight Watchers can play in tackling obesity more subtly than the 'don't eat this, don't eat that' brigade at the clinic.

Incidentally, Mr Barron's scorn for now-discredited Tory smoking policies was matched by his outrage over Boris Johnson: David Cameron's university spokesman took a permissive 'let them eat pies' attitude after Rotherham parents were photographed pushing pies and chips through the school fence to thwart healthier school dinners. Rotherham was embarrassed; Boris should have been, the MP said.

Basically, the Tory case made by health spokesman Andrew Lansley and his fierce ex-Royal Navy deputy Dr Andrew ('we must have fad-free public health') Murrison is two-fold: first, Labour has presided over rising health inequality, overweight kids, 'an epidemic' of STDs and booze-related deaths; second, public health budgets decreed by Whitehall are diverted to other projects or cut to meet Ms Hewitt's budget targets.

All true enough, and recorded in last summer's sharp report by chief medical officer Sir Liam Donaldson. MPs provide plenty of local examples every week. Nor is it good enough for Labour to counter that Mr Lansley's plans for an independent health board to take the politics out of NHS spending will struggle to reconcile independence with ringfenced public health money and targets. The time will come when voters may say 'let's give it a try'.

When I rang Dr Richard Taylor, the independent MP for Wyre Forest since 2001, for a reality check, he echoed Westbury's Dr Murrison, in wanting more evidence-based policy. Merging primary care trusts from three to one in Worcestershire will further erode local public health staffing. Directors of public health were fatally undermined when they were put on executive boards, so Dr Taylor resolutely believes. But that happened under the Tories, so the wheel goes round.

When Liberal Democrat Sandra Gidley protested that all the talk about more healthy school sports took her straight back to childhood misery, Tory MP Peter Bone protested that coming last at sport had made a man of his son: he is now an RAF pilot. So there.

Michael White is assistant editor (politics) ofThe Guardian.