Out of touch with the real world

It was perhaps the most telling image of the week: a sweating, floundering Prime Minister reduced to open-mouthed confusion when confronted with the problems of real people in the real world.

On the BBC's Question Time special, Mr Blair was "absolutely astonished" to discover that GPs are refusing to make appointments more than two days in advance, to comply with Whitehall's requirement that patients must be seen within 48 hours. He thought it "absurd".

But even then, he didn't grasp the point. He said he was sorry for the experience of "one person", only to provoke a storm of complaints from the audience that they too had suffered such bureaucratic, target-driven nonsense. A chastened Mr Blair promised to investigate.

Eight years on, isn't it a little late to wake up to what is really happening in the NHS?

He makes much of the extra billions for health and paints a glowing picture of new buildings, more MRI scanners and faster treatments. And to be fair, there have been some improvements.

But the rose-tinted view from Downing Street is far from the full story.

The appointments fiasco is only one example. Need to see your family doctor in the early evening or at the weekend? Hope for a home visit, late at night? Forget it. Under their new contract, GPs no longer need to be available out of hours.

Meanwhile, the targets culture distorts clinical priorities. The BMA warns that lives are jeopardised in A&E departments because of Whitehall's demand for patients to be treated within four hours.

Doctors must cut corners to meet that target, often by pushing patients into inappropriate wards just to get them out of casualty by the deadline. That leads to bed shortages and cancelled operations.

Lives are put at risk in other ways too. The MRSA superbug rages in hospitals, partly because managers are blocking requests to close infected wards so they can be properly cleaned. The reason? Performance targets again.

On and on it goes. Mr Blair points proudly to new scanners, while a third of them stand idle or under-used because of a shortage of radiographers. But there is plenty of money for the bloated army of bureaucrats appointed to enforce New Labour's obsessive targeting.

His failure to introduce genuine reforms in the NHS encourages waste and mismanagement on a colossal scale.

But as on Iraq - where he enthuses over democracy while closing his eyes to the 60 terrorist attacks a day - this Prime Minister sees only what he wants to see.

Rarely has the chasm between rhetoric and reality yawned so wide. Rarely has a politician seemed so woefully out of touch.

Toadies in ermine

A failed minister... a Tory turncoat... a gaggle of oleaginous sycophants... a junketeer... it would be difficult to find a more unimpressive bunch of has-beens.

Yet - with admittedly several notable exceptions - such are the ex-MPs chosen by Tony Blair to make Labour the largest party in a compliant Lords.

How contemptuously he treats a Second Chamber that has so often been the bulwark of our freedom.

But then, Mr Blair has always hated its ability to thwart his presidential power. He got rid of most hereditary peers - with no idea how to replace them - in the hope of turning the Lords into a rubber-stamp. And since that botch hasn't worked, he packs the place with toadies.

Examine his dismal list of placemen. Would you trust most of them to defend our ancient liberties if, for example, his Government again tries to jail people without trial or weaken our jury system?

This isn't just a question of honours for second-raters. This is another assault on our Parliamentary safeguards.