Peter Oborne

Now the real fight begins, and this time the Pentagon won’t help

Now the real fight begins, and this time the Pentagon won't help

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The central proposition behind the government's public-relations campaign since the end of the Iraq war is that Tony Blair has undergone some mid-life personality enhancement. We are now entreated to believe that the amiable, grinning weathercock to which we had grown accustomed has been replaced by a steely world leader. These claims do not square with the evidence of the last few weeks, during which the Prime Minister has attempted to steer the government back on to a domestic agenda.

Two weeks ago, at his latest Downing Street conference, the Prime Minister described public-service reform in the kind of portentous terms he hitherto reserved for the Iraq or Kosovo wars. He was banging the drum again on Tuesday over lunch with newspaper executives at the Savoy Hotel, insisting that failure to move radically would be 'a collective mistake of absolutely historic proportions'. If that proposition is true, it is a mistake that the Prime Minister seems quite determined to make.

As The Spectator went to press, the exact size of the Labour rebellion over foundation hospitals, the vehicle chosen by Tony Blair to take us forward to the sunlit uplands of a modern health service, was unknown. But the numbers hardly matter. By the time MPs mustered in the division lobbies it had become clear that the Health and Social Care Bill, which plays midwife to these foundation hospitals, is above all a colossal failure of nerve.

One can dimly see what the Health Secretary Alan Milburn, now emerging as one of the characters of the second Blair administration, is trying to do. Some of his fellow Labour MPs distrust Milburn, viewing him as the political equivalent of Joe Lampton in Life at the Top, John Braine's philandering working-class hero who is ready to ditch any principle and betray any friendship which stands in the way of his remorseless personal advancement. This is unfair. For one thing Milburn lives in a blameless state of cohabitation with his partner, a consultant psychiatrist. For another, it is simply wrong to accuse poor Milburn of trying to privatise/sell/close down the NHS at the bidding of Tony Blair. He is genuinely trying to make it better.

After six years in power New Labour has finally reached the identical conclusion as Margaret Thatcher and John Major did more than ten years ago. Central management does not work; what is needed is localism with a healthy element of internal competition. When the Tories proposed the internal market, Labour demonised it as a monstrous attempt to destroy the NHS. Frank Dobson's first action on becoming health secretary was to dismantle Conservative hospital trusts. It is a marvellous irony that Tony Blair, whose slogan on Election Day 1997 was '24 hours to save the health service', is now determined to condemn the NHS to the fate from which he claimed to be rescuing it six years ago.

Neither he nor Alan Milburn should be criticised for that. On the contrary, the Prime Minister and his Health Secretary should be congratulated on their outbreak of good sense, however belated. But they are guilty on another count: failure of nerve. The idea of foundation hospitals is based on sensible if hardly original insights, but has been pressed through with no vigour. There were plans to make them limited companies, give them robust borrowing powers, make sure they had at the very least an independent board of governors. All have been dropped to appease the Left. The government toyed with, then ditched, the admirable notion, greatly favoured by GPs, of fining patients who fail to meet appointments. The charge against Blair on health is that he is John Major without the conviction.

There is the same sense of déj