Leading article: Failure to reform

The idea that healthcare should be provided free at the point of delivery was the founding principle of the National Health Service. That is what makes a report published today by a distinguished group of doctors so shocking. They point out that an increasing number of patients are accessing private healthcare to "top up" what they receive from NHS services, undermining the egalitarian ethos that is supposed to underpin the British public health system.

This report reflects badly on the Government's record on health over the past decade. It blames the patchy provision of NHS services across the country as one of the reasons people are opting to pay for more treatment privately. It is not simply that we want a more lavish or personalised service; many of us are not happy about the treatment we can expect to receive on the NHS.

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In 1997, Mr Blair proclaimed that the electorate could "save the NHS" by voting Labour. And he has always fretted about the middle classes turning away from the public services. Now a two-tier health service is gradually developing, despite his best efforts. Those who can afford to "top up" are increasingly doing so. Those who cannot are left with a service that is frequently second-rate.

How has this happened? It is not because the NHS has been starved of funds. The health budget has tripled since 1997. And despite the complaints of the Unison delegates meeting at the moment in Brighton, the problem has not been a Government obsession with "privatising" the NHS. In fact, the opposite is the case. It has used the private sector too little to deliver NHS services. At the heart of the problem is the fact that the Government has soft-pedalled reform. The enormous sums of money coming from the Treasury have often not been spent wisely. This wastage has prevented the NHS from providing the level of care that the public expects.

So this report is not good news for Mr Blair's "legacy". But let us not forget it is also the legacy of Gordon Brown, who has been a uniquely powerful Chancellor for the past decade. Mr Brown has been notoriously resistant to many proposed reforms of the health service.

David Miliband, the Secretary of State for the Environment, appears to have ruled out challenging Mr Brown for the leadership. But the Chancellor is coming under increased pressure over his record in office. Some of the criticism heaped upon him of late has been justified. A lot of it has been unfair. But the scrutiny will only intensify.

It seems there may be a Labour Party "coronation" for Mr Brown after all. But the Chancellor should not imagine for a moment that his path to the premiership is going to be easy.