'Mr Dorrell cited that withering phrase used in school reports that Ms Hewitt is 'too easily satisfied with her own work''

In conversation with a Gordon Brown adviser this week I had a rare example of an NHS policy being mentioned by him, not me. The chancellor, it seems, has been very supportive of efforts to make it easier for pharmacists to deliver GP services, notably the reissue of regular prescriptions via electronic patient records.

The next day the PM-in-waiting also promised to 'do better' on NHS Direct, walk-in centres and specifically about the appalling case of Penny Campbell, who died of septicaemia after being given the brush-off eight times by an out-of-hours GP service in North London.

Indeed, when the Conservatives staged what they called a 'valedictory debate' for Patricia Hewitt proposing a symbolic£1,000 cut in her salary many of them did little but offer a litany of NHS horror.

Times are changing

These are strange times for national politics: ministers and MPs caught between two regimes from the same party; no general election; and uncertain how much change it augers.

Thus Tory health spokesman Andrew Lansley demands Ms Hewitt's resignation, even though everyone knows she's off at the end of June. I jotted down his litany of NHS failures parked at the health secretary's door since she took over from John Reid in 2005.

Primary care trust reorganisation and Lord Crisp's notorious July circular; payment by results and the collapsed tariff; the national IT programme; hospital reconfigurations and closures; doctors' and dentists' contracts; the EU working-time directive; waiting times; public health outcomes; cancer (etc) outcomes; MRSA; the deficits; the medical training application service...

Did I miss anything? Oh yes. Mixed sex wards. And complete loss of confidence in the Department of Health's political leadership by health professions and civil servants.

Improvement, but not enough

It is all good fun, but silly. It fell to ex-health secretary Stephen Dorrell to strike a more subtle note in the debate. 'Conservative politicians who say the NHS has got worse since 1997 are simply wrong. That defies the evidence and experience of those who use the NHS.'

But given the money poured in, it hasn't improved enough. Mr Dorrell cited that withering phrase used in school reports that Ms Hewitt is 'too easily satisfied with her own work'.

Oppositions are paid to be too easily dissatisfied. In vain had Tony Blair reminded David Cameron earlier the same day that an international survey of healthcare systems had just put the NHS ahead of Australia and Germany as well as the US and Canada. The latest Healthcare Commission report put patient satisfaction at 90 per cent, he added.

Yes, but it always does, retorts the unblushing Lansley, who also manages to rain on Mr Brown's pharmacy parade. The target for electronic transfer of prescription data should have been 50 per cent by 2005, close to 100 per cent now, but is actually 4 per cent. Even worse, only 1 per cent carry the bar code needed to dispense them electronically, he told MPs.

Inherited woes

All good sport and Ms Hewitt defended herself in her familiar, combative way. So to check her record I rang a couple of detached but kinder observers who agreed that most of her Lansley checklist was inherited.

'Her predecessors had done all the nice things like increasing pay and staff, she had to do the painful things,' explains Richard Brooks of the Institute for Public Policy Research.

On balance he thinks she's done quite well. Even the current training row reflects a better state of supply and demand. So does Professor Julian Le Grand, who used to be health's Mr Big at No 10.

'More patients treated and treated better,' he says.

But both agree Mr Lansley missed a major Hewitt error. By intervening on the advice of officials to promote the use of Herceptin against breast cancer she undermined the National Institute for Health and Clinical Excellence.

While Le Grand thinks she reacted too fast and publicly over NHS deficits (hence The Guardian survey which revealed a modest£500m surplus?), Brooks goes further. By intervening in some hospital reorganisations she also undermined local decision-making.

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