AH, THE PRICES one must pay . . . as Tessa Jowell surveys the ruins of her marriage this morning, and Patricia Hewitt the ruins of her permanent secretary, no doubt each will be reflecting upon the sacrifices a Cabinet minister must sometimes make to stay in the game. Ms Hewitt has lurched along at the top of the Department of Health for the past nine months like a drunk in A&E. Now she boldly lays down Sir Nigel Crisp for Tony Blair.

Some contrast in fortunes here. For what it’s worth, I believe Ms Jowell gave up her husband, temporarily or otherwise, for entirely noble reasons. And I say that not as a friend of hers — I think the last time we spoke was four years ago, when she berated me (terribly nicely, of course) for branding a speech of hers the worst new Labour speech ever made. I am not, like so many journalists seem to be, a millennium commissioner or a house guest of the Jowells or the Blairs.

I wasn’t even pleased about the Culture Secretary’s success in winning the Olympics, ghastly things. It is simply my opinion as a reasonably impartial observer who believes Ms Jowell to be a decent woman and a competent minister, that she does not deserve death by a thousand innuendos. And I find the accusation that has been thrown at the minister from some quarters — that she separated from her husband as a piece of political spin — revolting, and more suggestive of the deranged and sick state of mind of the people who make the allegation than of the mind of the Prime Minister or Ms Jowell. There we are.

No 10 stands firmly by Ms Jowell — yesterday, for instance, quite unnecessarily publishing a photograph of her on the front page of its website — because it believes her to be a fundamentally kind, optimistic, loyal and competent minister who lacks the angularity common in so many leading politicians. She even does “human”. Of how many other ministers can all that be said?

Yet compare Ms Jowell’s fortunes with those of Patricia Hewitt. The Health Secretary yesterday offered her “heartfelt thanks” to Sir Nigel Crisp, the man who resigned as NHS chief executive and permanent secretary at the Department of Health, and accepted as he did so his “accountability” for the problems during the period when Ms Hewitt was also nominally in charge. I bet she meant it, too. To be a Secretary of State in her position with all the trouble that the NHS seems to be in, and to have a fall guy knock himself over in front of you (not without a degree of encouragement from ministers and No 10), is fortunate indeed.

The Prime Minister’s spokesman said yesterday of Sir Nigel’s admission of responsibility that it was “part of being a leader”. So what of Ms Hewitt’s responsibility? With the health service simultaneously receiving record funding increases and heading for a record overspend; with the private finance initiative process stalled, leaving many trusts with needless expenditure; with the crucial new “payment by results” system having had to be redrawn because officials initially got their numbers wrong, it was about time that someone started asking what the hell was going on.

Hear the conclusion of one of Ms Hewitt’s own officials, someone without an axe to grind, who suggested two months ago that the Secretary of State is “completely out of her depth” and “doesn’t have a clue what to do”. Or of a senior manager who observed that Ms Hewitt struck her as “silly and self-obsessed”.

The good news is that, oddly, it doesn’t matter. The panic about over-spending is healthy, while concerns over the Health Secretary’s competence are broadly irrelevant.

What is going on in the NHS is that managers are having for the first time to confront the demands of the market rather than splashing taxpayers’ cash around and expecting the Department of Health to bail them out at the end of the year. After increases of 7 per cent a year for five years, the NHS will see a significantly lower spending rise next year, at the same time as the new payment-by-results system ensures that they only get paid for the work they do, rather than for a nominal block of work that they might do. All this as hospitals and local service managers are still getting to grips with new and more expensive doctors’ contracts that were rushed in by ministers and that have failed to deliver value for money.

The Treasury is insisting that managers get their books in order in preparation for the new regime. This year’s deficit, predicted to be up to £800 million but likely to end up as nearer £500 million, is a symptom of the laissez faire attitude of some managers who rely on the DoH finding a pot of cash to pay off overspends at the end of each year, as it always has done in the past.

Not this time. The squeaks and squawks spilling on to the front pages as wards are closed and treatments postponed until the next financial year are merely the protests of managers who are going to have to learn how to do their jobs properly. The DoH has sent in “turnaround teams” of officials as well as management consultants to help some of them. Ministers have also had to call in McKinseys, the management consultants, to the DoH to examine how the stagnant department works — or rather, how it doesn’t work.

The NHS is a complex business going through an extremely demanding transitional phase. The broader picture for the health service is pretty good: with funding increased to record levels, waiting lists on the way down, and even the Conservative Party signed up to an NHS free at the point of use and funded through central taxation, Labour could even claim at last to have “saved” it.

If Ms Hewitt can remain in her post, and keep on smiling while the Treasury, No 10 and the management consultants take control, she may even end up getting the credit for that. Especially if people keep falling under buses for her. Funny business, politics. As Tessa Jowell probably doesn’t say.

JOIN THE DEBATE
Send your e-mails from here

Times Recommends

• It’s the beginning of the affair
• Afghanistan: still a price worth paying
• Heroes of the downtrodden