Stop trying to be a he-man, Tony

Roy Hattersleyfinds the Prime Minister's latest speech stronger in its determination than in its int

There have been moments during the past three weeks when I have almost felt responsible for Labour's four consecutive election defeats. My criticisms of Tony Blair's expressed preference for meritocracy over equality provoked more than 400 letters from self-confessed social democrats. Each of the 37 who wrote to say I was wrong - including those who, unlike me but like the Prime Minister, explicitly endorsed the 1983 suicide note - justified that view with the identical argument. Tony Blair won. I (with the help of one or two others) lost.

Assume for a moment that I was the sole architect of Margaret Thatcher's triple triumph and that I compounded that offence by arranging for John Major's victory in 1992. Then add the sin of self-importance identified by Charles Clarke, chair of the Labour Party, in the way that Adrian VII was Pope. The indictment still suffers from one crucial weakness. It has nothing to do with the argument about equality versus meritocracy.

The only possible connection - once expressed by Peter Mandelson in his brash period - is the notion that what Labour stood for before Tony Blair became leader could never win a general election. Anyone who believes that has only to read Explaining Labour's Landslide by Robert Worcester and Roger Mortimore. Had he lived, John Smith would have won in 1997 and again on 7 June this year. The question facing Labour activists is not whether they can redistribute power and wealth but whether or not they want to pursue those policies. There is no respectable refuge in sighing, "If only we could".

Yet the Labour leadership refuses to defend its rejection of equality in anything like intellectually reputable terms. Perhaps the Prime Minister fears that to justify new Labour's beliefs is to concede that an alternative exists. But he cannot go through life like an old lady who imagines that if she drops a stitch all her knitting will unravel. The Labour Party is now in a mood to demand answers to the questions that have been on its conscience since 1997. It will no longer allow its convictions to be brushed aside - particularly if the Prime Minister continues to dismiss sensible arguments with the superficial generalities he employed in last Monday's Royal Free Hospital speech.

His claim that "if you are knocked down in the street and taken to a brand new PFI-built hospital rather than a run-down Victorian hospital, then you are probably relieved rather than angry" is almost certainly true. But what does it contribute to the argument about the best way to run the health service? And who are the ideologues who, the Prime Minister imagines, would rather see an old age pensioner wait for a hip operation than allow the health service to buy bed space in a private hospital? Certainly not me nor anyone I know. One of the problems of including that sort of nonsense in a speech is that it obscures the practical proposals. But perhaps it was the nonsense that the Prime Minister wanted to make the headlines. The pre-speech press briefing dwelt on his determination "not to flinch" from imposing change. The Downing Street press office thinks that muscle is an alternative to thought.

The way in which the news was managed illustrates the subtext to the Prime Minister's speech. It was intended to confirm that he had turned his back on the ideas in which Labour once believed. As always, the spin was what mattered. Unfortunately for him, the truth about employing private companies and private resources in the public services is exactly the sort of equivocal message that nature's advertising executives loathe. After months of careful research, the Institute for Public Policy Research concluded that sometimes it improves performance and sometimes it does not. If the Prime Minister could bring himself to say that, we could have a sensible debate. But as Matthew Taylor, the IPPR director, said on the night of the speech, Tony Blair "could not resist saying that the private investment brings in new money - that is untrue".

The explanation of why private management is not the sovereign cure for all the public sector's problems is buried in one of the speech's most revealing passages. "Private companies can, in many cases, be more responsive to the immediate needs of demanding consumers. If they don't [sic] they go out of business." Think about it, Prime Minister. Private companies perform best in the hope of increased profits and the fear of liquidation. Patients can- not shop around looking for the most responsive accident and emergency department. Nor will a hospital, in which private owners mismanage the funds, be allowed to go out of business.

Infatuation with private ownership and management is likely to produce the entrepreneurs' dream - assured profits and a guarantee against loss. Ofsted was explicitly critical of Nord Anglia's contribution to the management of education in Hackney, but its income from managing state schools is still rising by 30 per cent a year and the chairman believes that "the scope for expansion is good". At the Cumberland Infirmary in Carlisle (the first health service hospital to be built under the PFI) sewage spills into the operating theatre, the emergency generating system breaks down during operations, ward doors are too narrow to allow the movement of resuscitation trolleys and the laundry is flea-infested. Yet the "customers" still come. Paul Dyson, chairman of the medical committee, does not seem to think that the private involvement has made it "more responsive" to their needs. He says: "The developers always think of the bottom line. You have to hold a gun to their heads to get them to repair anything."

So the Prime Minister can be assured that it is not just "the spectre of Railtrack" - a subject that he thinks gentlemen should not mention - which will haunt the privatisation project. It is all the other recorded failures of the system and, for good measure, the manifold inadequacy of companies in the private sector. A quarter of a century ago, Harold Wilson made his famous joke about the Labour Party's enthusiasm for public ownership being based on the fear that the Co-op would become like Marks & Spencer. Who wants the health service to be like Marks & Spencer now? Or Marconi? Or Equitable Life?

To remind the Prime Minister of reality is not to reject all that he proposes for the reorganisation of the health service. But he encourages rejection by promoting the reforms in what has become his gung-ho style. If he persists in saying "take it or leave it", more and more people - patients as well as employees - will tell him "no deal", not because they want a fight but because his love affair with the private sector is so obviously irrational.

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