Blair fights back on health with fines for treatment delays

After the Margaret Dixon row, PM tries to regain initiative on the NHS with plan to penalise hospitals that miss deadlines

Tony Blair will seek to regain the initiative on health policy this week when he unveils plans to fine hospitals that fail to treat patients on time.

Tony Blair will seek to regain the initiative on health policy this week when he unveils plans to fine hospitals that fail to treat patients on time.

After a week dominated by the so-called Battle of Margaret Dixon's Shoulder, Mr Blair will unveil the new initiative on Tuesday.

The centrepiece of the party's "mini-manifesto" is a proposal to guarantee patients waiting for overdue treatment alternative provision. In a further introduction of market reforms to the NHS treatment will be paid for by the hospital at fault for the delay.

Labour's stategists contend that Michael Howard's decision to raise the case of Mrs Dixon, a 69-year-old pensioner whose life-saving operation was repeatedly cancelled, has backfired.

Mr Howard's claim that the Tories would make a better job of the NHS has been thrown into doubt by one of his own shadow ministers.

John Redwood, his spokesman on deregulation, claimed on Channel Four's Morgan and Platell programme last night that £4bn tax cuts already promised by the Tories were only a "down payment" - raising questions about how a Tory government would fund public services such as the NHS.

As Mrs Dixon gave back-to-back interviews from her front room on Thursday, Labour knew it had a cast-iron defence - but it was one it could not use.

Within hours of her case being raised by Mr Howard, Mr Blair was handed Mrs Dixon's medical notes. They showed that she was far from a typical patient waiting for orthopaedic surgery. While it was true that Mrs Dixon had had her operation repeatedly cancelled, the reasons were far more complex than Mr Howard admitted.

The file, prepared by Warrington Hospitals NHS Trust and sent to the Department of Health and forwarded to No 10, shows she suffers from at least six chronic conditions that dramatically increase the risk of her operation.

The surgery was cancelled because she needed an intensive care bed, for which emergency patients always take priority. The file offered a simple defence to Mr Howard's charge that the case illustrated a wider malaise in the NHS; far from being an example of routine failure it was, in fact, exceptional.

But as Alastair Campbell and John Reid planned the party's response, they knew that placing private medical details in the public domain could backfire spectacularly.

Memories of the Rose Addis affair are still fresh in the minds of many senior government figures, including Alan Milburn who was Health Secretary when Iain Duncan Smith raised the 94-year-old's A&E trolley wait. Then, Mr Milburn's aide, Darren Murphy, now a No 10 press officer, was accused of smearing Mrs Addis as a racist. Instead, Mr Campbell argued, it was better that the Health Secretary offer to visit Mrs Dixon. They hoped that by confronting the case head-on it would start to unravel.

In the event, no visit was necessary. Mrs Dixon herself began to drop details of her case into media interviews on Thursday. Once she admitted she had a weak heart, it gave Mr Campbell's team the green light to start briefing journalists about her other medical conditions - including her clinical obesity.

They said a plan to treat her on the NHS in a private hospital had to be scrapped after it refused to take her on the grounds that she was a "high-risk" patient. They also revealed that on the second occasion her operation was cancelled because the four beds in the unit were occupied by one patient with a serious head injury, one with acute renal failure, one with a life-threatening virus and one who had suffered a "post-operative collapse".

A leading orthopaedic surgeon agreed that Mrs Dixon's case was far from routine. Professor Chris Bulstrode said: "The NHS is not Tesco. We are not in the business of selling uniform goods. People are different and this lady is very, very different."

There were farcical scenes on Thursday as Mr Reid first promised to visit the patient at her home before it became obvious that she was being "minded" by Tory press officers. At one point there were negotiations about whether the party's minders should stand in the pensioner's garden during the Health Secretary's visit, before it was finally called off.

Senior civil servants in the Department of Health expressed distaste at the minister's handling of the Dixon case. "We have learned through bitter experience that it is better if the NHS rather than the politicians handle these cases, but I suppose just before an election we can expect more of this."

Despite the unseemly scramble over a pensioner's pain, both parties declare themselves satisfied this week. A Conservative spokesman said the case had helped raise "an important issue" about cancelled operations.

Great Ormond Street turns children away

London's leading children's hospital, Great Ormond Street, has had to turn away sick children, cancel operations and close one-fifth of its beds.

The world-famous hospital is facing severe financial problems ­ a £1.7m deficit ­ and has had to close up to 63 beds at any one time, as well as up to nine critical care beds, The Observer reports today. The news will re-ignite the debate on where the extra billions earmarked for hospitals have been spent. Nurses were also told that they would have to take a pay cut for extra work they did.