Leading Article: Time to lead, Mrs Bottomley

Leading Article: Time to lead, Mrs Bottomley

Virginia Bottomley knows that no news is good news. That was the message last November in a leaked memo by John Maples, the Tory party deputy chairman. The Tories, he warned, could not win on health, so it was best to keep quiet on the subject. Since then, the days when no breakfast radio programme was complete without a bowl full of statistics from the Health Secretary have become a memory. This week she quietly slipped out her announcement that the London hospital closure programme will go ahead. Perhaps she hoped that MPs would not make a fuss as they left for their Easter break.

Mrs Bottomley did not, however, reckon on the reaction of colleagues such as Peter Brooke and Sir John Gorst. Their protests may be dismissed as the special pleading of MPs in vulnerable seats where constituents are unconvinced that their hospitals should close. But anger at Mrs Bottomley's non-appearance was justified. Concern about bed closures is widespread and poorly addressed. Yesterday she tried to make amends by defending the closure decision in the Commons.

But it will take more than her lack- lustre performance to assuage concern about her handling of the NHS. For her attempt to bury this week's announcement amid a load of other written answers suggests that the NHS lacks leadership in a period of great change.

To be fair, Mrs Bottomley initially did well on the London hospitals issue. Rationalisation in the capital had been long talked about, but nothing had been done. Mrs Bottomley encouraged experts to reach a consensus, appointed the Tomlinson inquiry to produce a report, dispatched ministers to test opinion, and only then decided upon her plan.

Too little was done by the experts to convince the public, faced with queues at casualty departments, that closures were needed. But the main flaw in the process was that the analysis may be wrong. The Department of Health seems to have been swept along by a conventional wisdom which may have miscalculated how many beds London needs.

The London problem is just one example of a range of difficulties that can no longer be avoided. It is becoming clear that the managerial changes produced by the NHS reforms have raised broader questions that need to be answered. What, for example, are to be the ground rules for rationing healthcare in an NHS that seems no longer able to provide a comprehensive service? This issue is being tackled only on a piecemeal basis. Typically, yesterday's plans for dental care are a stop gap, which will not solve the crisis that the Government's own policies have created in part of the NHS. Likewise, we lack a vision of the optimal public/private split in healthcare and the balance to be struck in the NHS between competition and partnership.

Given these problems, the NHS needs a Secretary of State who is determined to offer a vision. Yet Mrs Bottomley seems reluctant to take up the role. This may be related to her disappointment at failing to win promotion in last summer's Cabinet reshuffle, despite having been at the Department of Health since 1989.

The temptation to fudge important issues is only increased by the Opposition's refusal to engage in any serious debate about the need for change in the NHS. But Labour's opportunism does not absolve Mrs Bottomley from facing up to the big questions. This week's events should teach her that she must now offer robust leadership.