The Sketch: Simon Carr

Alan Milburn has become much more likeable since the last election. It may be that he's become much less powerful (there's an inverse relationship between the two).

Gordon Brown keeps imposing cheap private sector solutions on him. Gordon's closest confidante, Ed Balls, has a wife called Yvette Cooper. She's come back from maternity leave to sit on Mr Milburn's front bench – perhaps that's part of it. But most of all, the minister seems to have glimpsed the underlying truth of the NHS. A service run by politicians, free at the point of delivery, simply can't do what they want it to do (get them re-elected).

That is what justifies the minister's brave, blue-sky decision to buy English patients their operations in France. Tory Tim Loughton declared nine patients had escaped the millions on waiting lists. He asked how much the operations cost and how far advanced were plans to send patients for operations in Malta, Turkey and Tunisia.

Mr Milburn said there were no deals to send patients to Turkey, Tunisia and Malta. So it was true! They are going to send patients to Turkey, Tunisia and Malta! Brilliant electoral strategy: a million holidays for voters, with medical care thrown in. We were still left asking how much the operations were costing.

Helen Jones (Lab) asked what progress had been made appointing local people on to Warrington's health authority and primary care trusts. A cubic foot of parliamentary effluent emerged from Hazel Blears (the minister couldn't be better named), prompting a testy supplementary from Ms Jones: "None, seems to be the word she is looking for." That was bad for Labour reasons. Oliver Heald laid out Tory reasons: the boards of Warrington's health authorities had five times as many Labour supporters as any other political affiliates. "Disgusting culture of cronyism!" he declared.

Ms Blears said: "There is no evidence of bias." She'll go far. And if not of her own accord, she'll be sent.

One Labour MP wanted to know how many hospitals had been paid for operations supplied to out-of-area patients. The cost of meeting other people's targets could be crippling. Mr Milburn admitted this was a good point. There was a fault line in the system.

The fault was the Government's. They don't pay promptly. Hospitals may wait for two years. That's prudence with a purpose: keeping the money.

Labour's John Smith teed up something that looked like a patsy. What steps was the minister taking to improve nursing recruitment? Mr Milburn modestly pointed out they were well ahead of their target for 20,000 extra nurses by 2004.

So there. The Sketch's cynicism decisively defeated. A target will not just met but be met well ahead of time. Active government. A victory for the state. Mr Smith had a sting in his tail. How many of these nurses – many from overseas – enjoy the same terms and conditions as British nurses? Ooh, yes, ouch.

Hang on, that reminds us, wasn't there a young minister of health from the old days? Idealistic, brave? One who encouraged a wave of health workers from overseas, to help solve a skills shortage? Enoch, wasn't it? Enoch Powell?

Did you know Alan Milburn's middle name is Enoch? Actually, it's not. But considering Mr Milburn's political journey so far, his final destination is very unpredictable.

Simoncarr75@hotmail.com