Margaret's shoulder and Michael's bare-faced cheek

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The War of Margaret's Shoulder tells us surprisingly little about the choice that voters face at the coming election. Last week the Conservatives publicised the extraordinary case of Margaret Dixon's repeatedly cancelled operation. And their point was? Michael Howard concluded in the House of Commons: "We will increase investment and improve the service so that we have a health service of which we can be truly proud." So will Labour. So will the Liberal Democrats. Indeed the Lib Dem leader Charles Kennedy went further at his party's spring conference yesterday, promising "good hospitals, run efficiently".

The War of Margaret's Shoulder tells us surprisingly little about the choice that voters face at the coming election. Last week the Conservatives publicised the extraordinary case of Margaret Dixon's repeatedly cancelled operation. And their point was? Michael Howard concluded in the House of Commons: "We will increase investment and improve the service so that we have a health service of which we can be truly proud." So will Labour. So will the Liberal Democrats. Indeed the Lib Dem leader Charles Kennedy went further at his party's spring conference yesterday, promising "good hospitals, run efficiently".

The only sensible conclusion to draw from the Conservatives' choice of case study would be that NHS managers ought to give greater priority to operations that have a poor survival rate. Clearly, it was unfortunate that Mrs Dixon's operation was cancelled so many times, but it was always because more urgent cases came along. What does not seem to have been a factor was the emotional burden on her and her family of preparing themselves for an operation that carried a 30-70 per cent risk of the patient's death. Yet if Mrs Dixon had been given priority on those grounds, it could have had a perverse effect on other, emergency, cases. It would not be wise to devise policy on the basis of one highly unusual patient.

Most people, we suspect, would agree with the Prime Minister that this was a rare and unfortunate case that tells us little about the current state of the health service. It will do nothing to influence people's judgements as to which party can be most trusted to run the NHS as public spending on it increases. If anything, Mr Howard's tactic is likely to rebound on him. The Labour fight back was instant and brutal, drawing attention to the Conservative plan to subsidise half the cost of private operations.

The Conservative policy is not as irrational as Labour paints it - and the description of it by John Reid, the Secretary of State for Health, as introducing "charges" to the NHS is wilfully misleading. To the extent that private sector capacity increased, the policy would relieve some of the pressure of demand on the NHS. The money that was used to subsidise private operations would be "taken out" of the NHS, but so would the operations. The objection to the policy is that it would use public money to help the better-off to jump the queue - which most voters rightly regard as fundamentally unfair.

Indeed, the great puzzle of last week is why Mr Howard thought that the Conservatives could gain anything by making an issue of the NHS. The result is not that most voters question Mr Blair's record on the NHS but that they doubt Mr Howard's political judgement.

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