We are incapable of having a serious debate over the NHS

'So Mr Blair comes under great pressure to use a cartoon word like "wreckers" to get his message heard'
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It's quite hard to make a public enemy of John Monks, the general secretary of the TUC. Not because he is some sort of pushover. Quite the contrary. His preferred style is to say his piece in private rather than in public. This isn't John Edmonds, a man who never misses an opportunity to attack the Government for deviating from the true path of Labour righteousness as defined by John Edmonds.

Exactly because he is a moderate, open-minded and disciplined man, therefore, it creates a marked frisson when Mr Monks accuses the Prime Minister of "juvenile" and "bizarre" language, and the Government of "erratic" behaviour towards the public services. No doubt his remarks were taken somewhat out of context. But they were still harsh. And it's a criticism that the Government, as most of its members know, could well do without.

First, however, consider two recent events, both germane to the so-called debate currently raging on the future of the public services. The first is the war of words that escalated during the weekend over whether, when first Stephen Byers and then Tony Blair juxtaposed the word "wreckers" with that of "reformers", they had in mind the trade unions as well as the Conservative Party. If they did, neither made it explicit in their speeches. But since Mr Byers did refer to "vested interests" and Mr Blair alluded to "small c conservatives" opposed to reform, the damage was done and a story was up and running. Mr Edmonds will no doubt spend his members' money on newspaper advertisements saying "So we are the wreckers, are we?", and Mr Monks has already been uncharacteristically sharp in his criticisms of the Government's weekend operation.

The second was the release on Friday by the Department of Health of its annual national clinical performance figures. These show modest – though not universal – progress in the indicators. For example, life expectancy has risen for men by 0.7 per cent in the last year and for women by 0.4 per cent. Death rates came down by 2.1 per cent for cancer and 5.2 per cent for heart diseases and strokes. Infant mortality has dropped by 3.4 per cent. Breast screening rates have improved by 2.4 per cent, and the number of heart operations increased by 10.5 per cent, and those for cataracts by 12.3 per cent.And so on.

No prizes for guessing which made the bigger story. Indeed, the new performance figures received minimal, if any, coverage. Yet which actually better informs the debate on progress or otherwise in the NHS?

I don't mean to suggest that the figures show some spectacular breakthrough for the Government. There may be grounds for suggesting that they hardly paint that rosy a picture of the NHS. But they are, or ought to be, at least as important an element of the debate as the din of wordzak currently surrounding any attempt to talk seriously about the NHS or, for that matter, other public services. So too are the figures expected today on the extra recruitment of nurses – though the recruitment figures for doctors are likely to be less impressive. These figures are particularly important given that most the speechifying over the weekend, on both sides, was largely free of new facts of any kind.

As it happens, Mr Monks deserves some sympathy. The conspiracy theory that Mr Blair, having made a speech in Newcastle defending public service workers in the wake of the Rose Addis affair, was now "correcting" his stance by being more consumerist is too facile. The apparent application of the term "wreckers" to RMT members by one of Mr Byers' briefers is actually pretty unexceptionable. But, at best, it unnecessarily complicated the "core message" of the weekend speeches.

The Government hasn't completely sorted out a coherent story – by no means impossible – for why the private sector is a disaster in railtrack but essential in boosting NHS provision. And it could do a little more to give Mr Monks some leverage with his own more troublesome affiliates by, say, being more willing to embrace the EU directive on works councils, something which has been already adopted by most progressive multinationals without capitalism showing any signs of collapse.

But a close reading of Mr Blair's text on Sunday suggests something else: that we are all, the media as much as politicians and union leaders, guilty of a two-dimensional caricature of sensible debate. For Mr Blair's message was not only warmly received by a Labour audience but also wholly appropriate for a modern Labour leader to deliver.

He did – again – defend public service workers. He issued as robust a defence of health provision free at the point of delivery as it is possible to do. He stated four coherent principles of reform. He rightly drew attention the Conservatives' desire to usher in a post-NHS era. And he pointed out, also rightly, that no one now regards it as a betrayal that Labour has lifted other taboos, from expelling Militant to replacing Clause Four. In that context, just what is wrong with the NHS using its new money to buy private capacity which doesn't yet exist in the public sector?

If you ask people whether they want more spent on the NHS they – rightly – say yes. If you ask them whether they are yet satisfied that the money will be well spent, they are likely to say no. Which is just what makes the case for reform.

The problem, however, is that this "neither old left nor new right" message, though simple, doesn't easily fit the cartoon model of speech, coverage, and reaction. In this model, either Mr Blair is pro-public service or anti, depending on which day he is speaking. We are all so keen to find the tiny nuance that indicates which, that we miss the much bigger point that he is in fact being wholly consistent. But it's the nuance, whether imaginary or not, that makes the story. And it's the story that, inevitably, creates the reaction.

There are several adverse results to all this. One is that Mr Blair comes under great pressure to use a cartoon word like "wreckers" simply to get his message heard. But another is that realistic debate is made much more difficult. The Labour Party, let alone the general public, is almost certainly ready for an open and adult debate on whether, for example, some 'hotel' charges, cushioned by large-scale exemptions, aren't appropriate for some non-clinical NHS services. But in the present climate you can only start it in tentative whispers.

Certainly Mr Monks has a point. Maybe the Government needs to do more to clarify a complex message of reforms which impose rigorous national standards and more devolution to local hospitals, schools and police chiefs. Maybe, too, it needs to emphasise how long a haul it will be, rather than raise expectations of a quick fix, as it has tended to do.

But let's not pretend – which Mr Monks, to his credit, doesn't – that Mr Blair is trying to privatise education and the NHS. There is a political dividing line on this subject. But it's between the parties rather than within them.

d.macintyre@independent.co.uk

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