TONY BLAIR has already promised that a Labour government would not tear up the Tory NHS reforms overnight.

So there is a need for distinction in the two parties' policies on the key battleground of health.

Labour apparently hopes that is answered today by declaring war on the hospital bureaucrats.

For despite Mr Blair's pledge less than a fortnight ago of stability for the NHS, Labour's front-bench health spokesperson Harriet Harman overtures this week's forthcoming draft manifesto launch with plans dressed up as abolition of its internal market.

The idea is worthy in theory.

They plan to cut the number of managers in the health service which, Ms Harman says, would release £100million - enough to fund an extra 100,000 operations - to be spent on patient services instead of administration.

And, fitting in with Labour's proclaimed fears that the NHS is being reduced to a safety-net service for those who cannot afford private medicine, this scheme boosts Labour's image as the truest friend of the health service by suggesting it will make it more efficient so that patients have no need to resort, in desperation, to the private sector.

This may make a fine headline election-wise for the party's manifesto, but the small print suggests that the plan is somewhat less radical and practical than Ms Harman's talk of abolition of the internal market and huge savings make out.

To begin with, Mr Blair has already made clear that the distinction between the purchasers and providers in the NHS - the health authorities which "buy" care for patients and the hospital trusts which deliver it - will remain.

Thus the market, a key component of the Tory reforms, will remain in place, requiring bureaucrats to run it.

Of course the real question, and one still not satisfactorily answered, is whether the business-style market has improved patient services.

Certainly, the government can point to more people being treated by the NHS, fewer on waiting lists and everyone empowered to complain about the quality of care and about delays.

But if this is a benefit of the market - rather than developments such as increased day-case surgery - there is no doubt that it has been bought at the expense of an explosion in bureaucracy.

However, it remains to be seen if it can be trimmed to the tune of £100million a year - modest though the sum may be in terms of the overall NHS budget - simply through the scrapping of annual contracts between purchasers and providers and replacing them with much longer-term arrangements, as advocated by Ms Harman.

Additionally, Labour's fixation with bureaucracy levels also seems to overlook the fact that thousands of NHS staff in management grades are actually involved in hands-on patient care, rather than paperwork.

The pledge, then, to reduce the number of pen-pushers may be less-workable in practice than it seems in theory - especially as the government has already set about that task itself.

It might, however, sound well as a manifesto headline.

Strange, though, that the traditionally anti-welfare Tories might have a better headline in the promise that they will increase spending on the NHS above the level of inflation while, according to Mr Blair, Labour has no immediate intention of pumping extra money into it.

Converted for the new archive on 14 July 2000. Some images and formatting may have been lost in the conversion.