Andrew Grice: The Week In Politics

The 'fixing' of the NHS will happen too late for Blair

Tony Blair has found yet another "legacy" issue: he wants to "fix" the problems in the National Health Service before he departs the political stage.

With that in mind, he summoned health trust chief executives to Downing Street on Wednesday for a "briefing session" about the latest financial problems engulfing the service.

No 10 insisted it was not a "summit", which smacks of crisis management, but an early-morning "seminar" to bring the Prime Minister up to date and ensure best practice is spread throughout the NHS on eradicating the deficits built up by a minority of trusts.

For Mr Blair, the bumper crop of headlines about health service job cuts - now totalling more than 7,000 - is both a curse and an opportunity. They are a worrying political problem because Labour has doubled health spending to £94bn a year since 1997 and the public are rightly asking: where has all the money gone and why are "they" sacking nurses?

This slots perfectly into David Cameron's battle plan for the next election. He can argue that Labour has poured billions down the public service drain without getting value for money, and say the Tories will complete the reforms Labour bottled.

The daily dose of health service job cuts reminds Labour ministers of how they used to exploit major redundancies in industry when the Tories were in power and unemployment was a political hot potato. Now the boot is on the other foot.

Whether the Tories will win the voters' trust on the NHS is another matter. But, after ditching their "patients' passport" plan to subsidise people opting for private treatment, they might just be in with a shout if people think Labour has failed.

Yet the health service's problems also present Mr Blair with an opportunity to remind voters - after his ill-fated travels abroad and the highly damaging "loans for peerages" affair - that he is "engaged" on the issues they care about.

He may have banned his aides from using what they call the "L-word" - securing his legacy - but he sometimes gives the impression of a man who is casting around for one.

Once upon a time it was ending Britain's half-in, half-out relationship with Europe by joining the single currency, now long forgotten. More recently, aides have talked up a long-term solution to pensions, an issue on which Mr Blair's differences with Gordon Brown remain. Laughably, Blairites have even flown the flag for a mainly elected House of Lords and state funding for political parties - matters in which the Prime Minister showed little interest until "loans for peerages" erupted.

Other potentially positive ideas in the Downing Street crystal ball include pulling British troops out of Iraq and Northern Ireland by the autumn of next year.

But, as the Metropolitan Police inquiry into the awarding of honours gets uncomfortably close to No 10 by extending to Mr Blair's flagship city academy programme, it looks increasingly difficult for him to achieve what all politicians want but few achieve - to go out on a high.

If anything, Mr Blair has gone back to basics by trying to turn round the oil tanker of the NHS. Along with Europe, transforming public services was Mr Blair's other personal goal when he came to power. With his education reforms bogged down in a messy battle with his party, at least the health service is something which unites the Labour Party. No major legislation is needed, so the scope for rebellion is limited.

There is another reason why the NHS appeals to Mr Blair. If he can make his reforms work, there is a chance he might leave a genuinely good legacy if the Government hits its target by 2008 that no one will wait more than 18 weeks from GP referral to treatment. Conveniently, this goal keeps a 2008 retirement date in play for Mr Blair, at a time when Brownites want him out this year or next.

In the short term, there is much firefighting to do on the health service, which has returned to the front line of political debate. Mr Blair will make a big speech on health on Tuesday and two days later Patricia Hewitt, the Health Secretary, will brief the Cabinet on the current turmoil.

Who is to blame? The Government and health managers blame each other but should probably share it. Ministers have bombarded the NHS with targets, circulars and centrally driven initiatives. If the current measures had been introduced five years ago, we might now be in a position where things really could only get better.

Although Labour's reforms are broadly right, some local health chiefs have not implemented them with much commitment. The changes have shone a spotlight on deficits that have been covered up for years. As one health authority leader admitted at the seminar: "I used to fix problems by shifting money round the system. Now I fix them by implementing reform. The reforms are biting, and it is working. The pain is part of going through the change."

Ministers will have to grin and bear it. The job cuts worry Labour MPs but should eventually help provide the health service people want. That means a smaller role for big hospitals, with patients treated closer to or at home.

Hiring community nurses doesn't make headlines; cutting hospital nurses does.

The problem for Mr Blair is the current problems are likely to last beyond the next election. The health service is not going to be "fixed" quickly enough for him to get the credit.

a.grice@independent. co.uk