That Blair did not sack Ms Hewitt in his panic reshuffle on Friday simply confirms that what he really intends is the sack of the NHS.
Shortly after his election in 1997, he exhorted his drooling NHS acolytes that they had no more than 10 years to 'save the NHS'. He embarked on an ambitious programme of reform (or modernization as he would prefer it known). Few would argue with the need for reform and not many with its direction. The problem has been with the manner of its execution.
The irony is that those of us NHS professionals who have dedicated our working lives to the NHS would have gladly 'saved' it for him, given half a chance. For some reason Blair resents professionals and professionalism, and has done a good job of carrying the media with him. He sees doctors and nurses not as much as caring as heavily unionized and self-interested. The reception afforded Ms Hewitt at a nursing conference last week will have simply reinforced that view.
The reality is that most of us are exceptionally hard-working and dedicated to doing the best we can for our patients, and for the NHS generally. The new consultant contract was predicated on the belief that we are all lazy sods and that management needed new levers to bring us into line. In truth, the necessary levers were always there but few had the leadership qualities to use them effectively.
Just last week a good friend of ours had an elective surgical procedure at our hospital. All went well and after her discharge she called me to say just how amazingly well it had all worked. She also noted just how hard the nursing staff were working and the long hours the consultants were putting in. (Thanks to the European Working Time Directive, this degree of commitment is now rarely apparent in the junior medical staff.)
As the media has been quick to spot, the new consultant contract proved more expensive than anticipated and it is now being 'blamed' in part for the NHS overspend, when all that has happened is that a bit of transparency and accountability has been brought to play which highlights how hard the majority of consultants have actually been working. More than they reckoned— and now we have the extraordinary spectacle of a consultant workforce that is now financially substantially better off but more demoralized than ever. Thank goodness Andrew Foster has decided to move on.
So what happens next? Well, having heavily overspent on salaries and disastrous PFI contracts, the NHS will have to claw back as much as it can by wielding an indiscriminate axe here and there. It is going to be very painful and the worse is yet to come. Nor would Gordon Brown have it any other way: the Treasury has long been convinced that the NHS is a lost cause financially and he really must be smarting at how his generosity has been rewarded.
And that's before we even consider Connecting for Health...
Blair is a conviction politician. No harm in that except that he also believes (more strongly than anything else) that the end justifies the means. I'm not certain it ever does but, to be sure, the two don't mix well.