Mr Blair, it is time to turn your attention to the troubles here

He is in danger of falling into the Gorbachev trap: acclaimed abroad while reforms stall at home
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AS WE now know, there are two Tony Blairs. One is the kindly shepherd of the Third Way, a reasonable sort of guy who just wants us all to graze peaceably together in the moderate, sunlit uplands of New Britain. The other is the Spartan son of Thatcher who takes no prisoners and lashes out at ingrates in his way. The second Mr Blair has been operational this week, departing from his set speech to a City audience to denounce "people in the public sector" as being "more rooted to the concept that `it has always been done this way' than any other group of people I have come across".

There is only one John Prescott, and yesterday he leapt to the defence of Mr Blair's victims, lavishing praise on the public sector as the great civilising force of Britain this century. Repeat that to yourself the next time the bins aren't collected or you've waited three hour in Our Patients.

For all that it is never wise for a prime minister to launch attacks on entire groups of people (otherwise known as voters), especially not when he has styled himself the leader of the People's Party. Doing so in the middle of a paean to the nation's money-makers and entrepreneurs was not such a great idea either. I am all for Mr Blair telling it to the unions straight, but it would be better for him to do so in front of the relevant audience and confront the backlash there and then.

Some confusion is evident in Mr Blair's attitude to the public sector. Only a couple of months ago, he was praising the public service ethos, vowing that New Labour would uphold the public sector and try to persuade more able people to go and work in it. Now he portrays it as a ghastly redoubt of Old Labour ways. You cannot, in the Blairite lexicon, get any ruder than that.

His tetchy tone may, as Unison's Rodney Bickerstaffe suggested, be the product of the accumulated stress of the Kosovo war and a gruelling week spent trying to rescue the Northern Ireland peace process. But the decisive prod to his outburst came from the British Medical Association conference. The BMA is, and has always been, a deeply protectionist organisation. This week, it has behaved like any other raucous trade union, finding a thousand different ways to say "no" to modernisation while reserving the airs and graces of a professional organisation claiming to speak for patients' interests.

The Association's attack on what one speaker condemned as "creeping consumerism" and another as "populism" in the health service is symptomatic of doctors' reluctance to apply to themselves the same standards of accessibility they would expect from other professionals. GP surgeries limit their opening hours to the times when the majority of the population is at work. Their inflexibility is already channelling those who can afford it, and have access, to private walk-in clinics such as those that are springing up in London.

Now, in the Government's proposals for NHS walk-in centres, the GPs face the prospect of competition inside the public sector, and mighty is their wrath at such a prospect. The 24-hour NHS direct advice line met with the same self-interested rejection. When doctors kick up such a fuss about minor ameliorations, how can we be expected to take seriously their complaints about the lack of consultation they receive on more serious and complex matters?

Mr Blair is justified in his frustration at having failed to export reforming zeal to the public sector. But the initiative is there for him to take. If he wants to change attitudes in the public sector, he must give a clearer lead in the debate about the future of the NHS. It is time to shatter the cynical illusion that we can have a universal, and universally free, service without raising money from charges or raising taxes.

Institutions shape people. One might as well rail at Old Etonians for being too confident as complain that public sector workers are resistant to change. In both cases, environment has forged attitudes.

Whether the Government makes giant strides or takes faltering steps in tackling under-performance in hospitals and schools will determine whether we look back on it in years to come as a great reforming administration or just a moderately competent one that left the most grievous problems of the public services unaddressed. On education, it has begun to make headway. Having started out attached to the mantra "standards not structures", the Government has recognised that the two are inseparable. It is now prepared to intervene where local education authorities are failing to deliver.

With health, no such forward thinking has been encouraged. The appointment of the avuncular Frank Dobson was a signal that all Mr Blair intended to do in his first term was hold the fort, absorb the slings and arrows of the predictable winter crises and the junior doctors' threatened revolts over hours and pay, while any serious thought about how the service was to be funded and sustained in the future, as both expectations and demand rise, were triple-locked in a safe marked "To be opened only after the next election".

Now that Mr Blair has embarked on a course of confrontation with the medical profession, he would be wise to work out what he hopes to gain from it. The most tricky balancing act a reforming government has to perform is persuading groups to accept change while not worsening morale in the process. It is no use having the Private Finance Initiative help build spanking new hospitals in partnership with the private sector if a lot of the people who work in them feel embattled and resentful. Nor is any purpose served by picking a fight with the doctors unless you have first established what it is really about.

We may well look back on the last few weeks as a defining period for the Blair government. One grave danger lurks for Mr Blair, which we might call the Gorbachev trap. Mikhail Gorbachev garnered his greatest popularity abroad while his reforms stalled at home and his popularity drooped. The more successful he became on the world stage, the less loved he was back in the USSR. Mr Blair is similarly adroit at burnishing Britain's image in Europe and beyond. His handling of Kosovo and Northern Ireland have established him as possessing the stuff of great statesmanship. But his domestic reform agenda is in trouble.

Welfare state reform is stuck in a directionless mire; the Transport White Paper has provided a textbook casus belli between a superministry and the Treasury; the Home Office has made a pig's ear of passports, and we have too many rows in the NHS without enough reforms to show for them. None of these are irredeemable problems. But they do demand Mr Blair's urgent attention if he is not to be perceived more competent in dealing with matters of state than in improving the state of Britain. The Home Front is the one which now needs his leadership most urgently.