FRANK DOBSON might have been expected to ride in triumph into this year's UNISON Health Conference.
He was the first Labour Health Secretary for 18 years, addressing an audience that had longed for the ousting of the Tories, and speaking for a government with a massive mandate to rescue the NHS.
In the event, things were very different. The normally rumbustuous Dobson sneaked into the conference, refusing to meet even the handful of Blairites selected by the UNISON bureaucracy as a suitably tame "focus group". He gave a nervous, low-key speech - and then he was gone, refusing to answer any questions, running from even the hint of criticism or accountability.
Dobson's door may be closed to health workers and the unions, but it appears to be open to all kinds of unsavoury and right wing academics: only a few days earlier he had declared to a conference of NHS managers that "professional opinion" was now "agreed" that we need fewer hospitals. This went down well with health chiefs themselves embroiled in hospital cuts and closures, but Dobson really should get out more, and find out what people committed to the NHS are saying.
Same speech
With this exception, Dobson's UNISON speech was very similar to the one he gave to the NHS bosses. Speaking just two days before Gordon Brown's budget, offered only two glimmers of popular radicalism - promising to work with Jack Straw to jail people (many of them mentally ill) who use violence against health workers, and calling on NHS Trusts to open their meetings to the public.
Dobson offered no clues on how Labour plans to wind up the chaos of the Tory internal market system, no detail on what system is to replace the two-tier nonsense of GP Fundholding, no hope of any end to the continual squeeze on NHS pay, and no promise of any let-up in the tide of service cuts and hospital closures Labour has inherited from the Tories.
Delegates who concluded from this that they should expect the worst may have been pleasantly relieved by Brown's announcement of an "extra" £1.2 billion for the NHS-until they realised that none of this money is available until next April, and that it takes the place of the normal autumn spending round.
While it represents a considerable (2.2%) increase on the standstill 1998/99 allocations proposed by Kenneth Clarke last November, this money falls far short of the real terms increase required to preserve front line services, and the jobs and living standards of 1 million NHS staff.
Worst crisis
Despite Brown's apparent generosity, the NHS faces possibly its worst-ever winter crisis this year, with many health authorities and Trusts already reduced to little more than an emergencies-only service for the foreseeable future as they struggle to deal with new cuts on top of £300m in deficits carried over from last year.
Brown's limited cash handout also carried a sting in the tail: he insisted that the money was only being made available on the strict understanding that a new rationalisation of London's hospital service would begin next Spring.
A key factor in Labour's electoral success in London on May 1 was public opposition to the Tory plans to decimate hospital services, with 14 on the list for closure: Tory MPs toppled like ninepins around threatened hospitals, notably Edgware, Queen Mary's (Roehampton) and Oldchurch (Romford).
Labour had pledged a moratorium on hospital closures and an in-depth 12-month review of health services in the capital.
In the event, to the anger and exasperation of campaigners and Labour activists, the incoming government decided within days to rubber-stamp the closure of Edgware's bitterly-defended Accident & Emergency unit, allow a succession of small-scale closures of wards and services across London, and restrict the review and the moratorium to just four months.
Although the review panel includes a number of noted critics of Tory health policies, notably Professor Brian Jarman who openly challenged the continual reduction in numbers of beds, Gordon Brown's declaration that its findings are expected to result in a further rationalisation raises serious doubts on how detailed and objective the review will be.
Conspicuous by their absence from the list of hospitals to be examined by the review are the threatened Guy's Hospital (where Trust bosses are accelerating towards closure) and children's services in Hackney, which could be axed without replacement.
However, unlike the Tories' Tomlinson Report of 1992, it is inviting written contributions from individuals and organisations No holds barred More ominous, perhaps for those who live outside London, Brown has also pledged to complete the root and branch "no holds barred" financial review of the NHS. This is the review which has triggered speculation that charges might be introduced for prescriptions for "wealthy" pensioners, for seeing GPs, or for stays in hospital.
All of these options have previously been surveyed - and rejected - by the Tories as not offering sufficient revenue to justify the huge political backlash that would be triggered by implementing them.
But the day after the Budget Labour went on to implement another Tory policy which Major's government failed to get off the drawing board - the Private Finance Initiative.14 PFI-funded hospital development schemes, costing an estimated £1.3 billion are to be given the go-ahead by the government, despite the fact that nobody yet knows how much these schemes will cost the Trusts concerned.
Consortia of companies will design, finance build and own the new hospitals, which will be leased back to the NHS on long-term deals guaranteeing profits for 25-60 years.
For the first time since Labour nationalised the patchwork of private, charitable and municipal hospitals to form the NHS in 1948 companies will be able to make profits from owning front-line healthcare facilities.
The PFI policy, which has only drawn in the private firms by guaranteeing that the government will underwrite deals signed by Trusts which may later go broke, is in stark contradiction to Gordon Brown's insistence on imposing rigid limits on spending.
The long-term costs of raising the money from the private sector rather than from government funding could be massive: and the costs of servicing this new capital investment will be added to the costs of each item of treatment in the Trusts concerned, while the health authorities which must buy their services face cuts in their budgets. Private profits will therefore be piled up at the direct expense of patient care.
With the budget, Labour has marginally relaxed the threatened Tory squeeze and given a tantalising glimpse of what they could have done with a majority of 179 to rescue the NHS.
Ominously, in the background, right wing think-tanks and empirebuilding consultants are floating schemes for fewer, bigger hospitals, for selective charges, for "hypothecated" taxes - anything but the simple answer, the proper funding of health care from mainstream progressive taxation.
Rrown mav have cheered un some of the troops, but the battle lines in defence of the NHS will inevitably begin forming up again as soon as the temperatures begin to drop in the autumn.
NELPARE STATE Soci is uț