Health battle on the home front

Tony Blair knows he will be judged on the health service

		By Nyta Mann BBC News Online political correspondent

Straight from dealing with the war in Afghanistan, the government has plunged into a battle over the NHS.

With the health service at the top of voters' lists of concerns, Prime Minister Tony Blair knows that however his wartime performance may be judged, health is an issue that will play a decisive role in his government's re-election.

A trade unionist at Tuesday's Westminster rally to celebrate the public services

At first sight, Health Secretary Alan Milburn's announcement of a deal that will see the private, Bupa-owned Redwood Hospital devote itself wholly to NHS work would appear an obvious, straightforward solution to help bring down waiting lists and stem the cancellation of routine operations.

But as you might expect, the reality turns out to be far from simple.

Trade unions, busy having earmarked Tuesday as the day to "celebrate" the public services with events and rallies at Westminster, are deeply unhappy at the deal.

Fear of undermining NHS

They point out that although ministers have said any NHS staff working under Bupa's private management at the hospital will have NHS standards and conditions, the public sector ethos cannot be grafted onto the private sector in this way.

Labour MPs, many of whom have signed a Commons motion backing the "renaissance of the public service ethos" and emphasising that "directly" funding, staffing and managing public services was the way to bring about improvements, are extremely uneasy about the deal.

Their worry is that the NHS could in effect end up propping up and even giving new life to the private sector - which if true could only serve to undermine the principle of universal health care to all who need it.

After all, what does Bupa, which is a private firm not a philanthropic venture, get out of it? As well as a profit, the company will enjoy the stability of a steady and large contract.

Goverment wrangling over funding

News of the deal, still to be signed, has also emerged against a backdrop of serious confusion and evident internal wrangling within the government.

First Chancellor Gordon Brown uses last week's pre-Budget report and the Wanless study of NHS funding to declare that increased cash for public services implies tax rises to pay for it - something of a landmark admission for New Labour.

Then Mr Milburn and Labour Party Chairman Charles Clarke express their backing for a hypothecated health tax, only for Mr Brown to later have the issue ruled out of play.

Alan Milburn was in favour of a hypothecated health tax

There is also Mr Blair's "commitment" to increase health spending to the European average, which he restated at prime minister's questions.

Mr Brown is understood to have been unhappy at once again having his hands tied as a result of Mr Blair finding himself facing a difficult question in a tight spot.

Obligingly, he swiftly retreated on the pledge and downgraded it to a mere "aim".

In the meantime, front pages of newspapers like the Daily Mail and the Sun carried tax-hike headlines guaranteed to send Downing Street into a panic.

Labour anxiety

The lack of apparent coherence signals how anxious Labour is about the issue. The party already knows its failure to deliver expected health service improvements has hurt its standing with voters.

Significant spending boosts have been allocated to the NHS and more is being promised, all in order to make up for under-investment that the government says stretches back decades.

The fear that the spending increases themselves are not enough to match the public's expectations means Mr Blair is determined additional measures be taken to get the waiting lists down before they do his standing more damage.

Downing Street has made clear that any means of bringing about the 20 treatment centres promised by 2004, of which Redwood will be the first, will be considered, as long as they fit Mr Blair's criteria of "does it increase capacity? Does it give good quality care? Is it value for money?"

Having put health at the very top of its domestic concerns, which Labour know tend to be the only ones that count when it comes to winning elections, the prime minister almost certainly has a further, unspoken criteria: will he be able to see off the opposition of the trade unions and concerns from his own side?