`Back to the future' as Blair targets BMA

IT HAS been back to the future in Belfast this week. Angry doctors cheered and clapped the leaders of the British Medical Association as they sought to turn back the clock and restore the association to its traditional trade unionist position of protecting its members and opposing change in the Health Service. That was the Prime Minister's view.

On Monday Ian Bogle, chairman of the BMA, launched an astonishing personal attack on Tony Blair, accusing him of alienating the entire profession. Mr Blair hit back on Tuesday, complaining he bore the scars on his back of trying to persuade public sector institutions - and the BMA was uppermost in his mind - to modernise. Yesterday he accused the BMA of seeking to scupper the largest hospital building programme in NHS history through its opposition to the Private Finance Initiative, the scheme for raising finance from commercial organisations rather than the Treasury.

The sharp change of mood after the two-year honeymoon with Labour illustrates how deep-seated the problems of the NHS are. After the exhilaration that accompanied Health Secretary Frank Dobson's announcement a year ago of an extra pounds 21bn for the NHS over the remainder of the parliament, disappointment at the lack of improvement in conditions on the ground has been intense.

To outsiders it appears astonishing that so large a sum of money has had little effect. But the extra cash only came on stream in April and a large proportion of it has been centrally earmarked for cutting waiting lists, reforming the GP service and boosting nurses' pay, leaving little flexibility at local level. Doctors feel frustrated at their lack of room for manoeuvre - frustration expressed by Dr Bogle, who complained of feeling abused and exploited.

The current row is, however, a minor skirmish compared with the battles of the past. In 1991, as the Tory government prepared to launch its hated internal market, the association launched a pounds 3m advertising campaign opposing the reforms in a head-to-head clash with the Government. Posters featured a picture of the then Health Secretary, Kenneth Clarke, and the slogan "what do you call a man who ignores medical advice?" Mr Clarke had taunted doctors by accusing them of "feeling for their wallets". A decade ago in 1987, the NHS arguably endured its worst crisis when hospitals across the country ran short of cash and were turning away patients.

Matters came to a head when the Royal Medical Colleges made an unprecedented appeal to the Government to provide extra funds. Ministers relented only when Birmingham Children's Hospital began cancelling heart operations for babies.

The latest spat is about style rather than substance. Doctors' leaders are smarting at being ignored over plans to introduce walk-in clinics and the telephone advice line, NHS Direct. They are dismayed at the pace of change and angry at the diversion of resources from the treatment of serious to trivial conditions.