Leading article: An unhealthy lack of opposition

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Tony Blair says the date of his departure from No 10 will be determined at least in part by the time it takes to sort out the NHS's financial problems and drive through the NHS reforms. Such a pledge, taken literally, could imply a premiership without end. The NHS has lurched from crisis to crisis since its foundation almost 60 years ago, and in this case the past almost certainly is an accurate guide to the future.

Nonetheless, the present crisis is the worst ever - a record deficit expected to be around £800m after years of unparalleled growth, which has seen the NHS budget climb from £34bn in 1997 to £92bn in 2007. The public is puzzled, while there is panic in the Department of Health, despite protestations that the overspend amounts to less than 1 per cent of the NHS budget. Balancing the books will involve pain - already seen in recent job cuts - and ministers have decided to don hard hats well before the next general election.

But where is the opposition in this crisis? At best, these problems are evidence of gross inefficiency and mismanagement. At worst, they reveal far more fundamental problems with a monopolistic service. So this should have been the excuse for the Tories to launch a debate about the future funding of health care. Papers would be published calling for the break-up of the NHS and its replacement with innovative schemes modelled on better-functioning systems overseas.

Instead, there is silence. David Cameron has nailed his colours to the NHS mast and ruled out extra private funding, thereby closing down debate. The Liberal Democrats, also under new leadership, are searching for ideas as well, although they are likely to remain statist in their approach. The result is that at a crucial point in the NHS's history no attention is being paid to how we will care for our health in the future - and how we will pay for it. Is the NHS doing what we need it to do? And in the way that we want?

The present crisis proves that throwing money at the health service without adequate reform will not sustain it in the long term. The vast investment has been used to raise salaries, and to turn the handle faster - cutting waiting times - but without achieving any real structural change. Ministers appear to have belatedly recognised this omission and Patricia Hewitt now faces the tough task of rectifying it. But the Tories appear dumbstruck on the most important domestic issue on the political horizon, and one where they could show some radical credentials. Let us hope they find their voice soon.

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