The problems of the NHS are too complex to be reduced to a single side of A4. Tony Blair’s presence at yesterday’s event, though, showed that Downing Street has arrived at Phase 1 of Sir Ian’s model. But there is a wider danger in misunderstanding the problems besetting the health service. Perspective can be easily lost in the blizzard of job losses and red ink that, convention assumes, spells crisis.

Some 7,000 jobs have been lost in recent weeks. This makes for bad headlines. Some of the losses will undoubtedly be felt by patients. But they need not be disastrous for future healthcare. Even if the number of redundancies triples from the current level, it will represent just 10 per cent of the extra staff recruited to the NHS since 1997.

Job losses are not necessarily a sign of failure. They are more accurately a sign that in boosting the NHS payroll from a million to 1.3 million in just six years, the Government concentrated too much on numbers and not enough on the types and qualities of recruits required to flesh out phased NHS expansion. The result is likely to be high medical unemployment in the coming years. There are, for instance, more medical trainees emerging from college than jobs available. This is more a failure of political and strategic management than a healthcare crisis.

Similarly, context is required for the anticipated £700 million-plus NHS deficit for 2005-06, around 1 per cent of its budget. More than three quarters of trusts are in the black: 77, some 14 per cent, have a deficit of less than £5 million; 57, or 10 per cent, have a deficit of more than £5 million. Such deficits seem inexcusable when set against the 40 per cent rise in health spending since Labour came to power. There have certainly been problems with the way that money has been spent, notably on the ill-constructed financial settlements that are making doctors among our wealthiest citizens with little productivity improvements in return. Many of the financial problems, though, lie in shady accounting techniques, decades old, that the Government’s market-driven reforms have forced into the limelight.

The reforms will bring some pain to some quarters. Some hospitals, when paid by results, may be forced to close. But patients, if they are able to receive better care elsewhere at less cost to the NHS, may benefit. Such reform is necessary to induce required flexibilities and efficiencies. This does not mean the Government has handled the NHS well. The decision to redraw yet again health authority boundaries is misconceived and looks like an attempt to appear busy. Moreover, historians may judge that the greatest tragedy of the Blair Government has been to throw money at an unreformed NHS, and to bring in reforms just as the spending taps are being tightened. The NHS is not in crisis. At least, not yet.

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