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Allyson Pollock is moving. Ministers and those with a vested interest in the government's private finance initiatives (PFI) would doubtless happily fund a one-way ticket to Outer Mongolia, but their most pertinacious critic is only going as far as Edinburgh.
Currently professor of health policy and health services research at University College London, and director of research and development for the UCL Hospitals NHS Trust - she has always maintained a foot in mainstream medical practice alongside her policy interests - she is to be the head of Edinburgh University's new centre for international public health policy.
Far from diverting her from the policy critiques that have made her some high-profile political critics, she believes the move will aid her work. Aside from the inherent congeniality of such a post for a native of Stirling, she says: "The important part is that it is a joint venture between the medical school and arts and humanities. It recognises that public health has to go beyond medicine. It has to engage philosophers, accountants and economists, management theorists, sociologists and everyone else with a contribution to finding the best way of doing things."
While hers is the only name on the dustjacket of her book NHS Plc, she says: "That is just the way publishers work", and turns the volume to the title page, where four other names are to be found. She says of her collaborators at UCL and in other universities: "Our work is done collaboratively by people who believe in public health and are motivated by the collective good of society. I am only the bandmaster."
Good bandmasters do more, though, than simply play through others' tunes. Pollock's ability to direct, analyse and articulate research on complex public issues demanding competence in several disciplines might seem surprising in an academic rooted in a single discipline. "I did a BSc in physiology, and then my medical studies, at Dundee. I came from a fairly conventional middle-class background and a family with a strong medical tradition, although my father was an engineer."
She might very easily have ended up as a consultant specialising in diabetes. What changed her direction was her first job in London, for about a year from March 1986, as medical registrar in Hackney. "I had just had a lovely time for 18 months in Leeds, the last year at St James's hospital. Then I came to London. It was a seminal experience for me. I had never seen such poverty or pathology, neglect and decay. I realised the inequalities not only in society, but also in the medical profession.
"A lot of consultants had joint appointments with Bart's. If you wanted to see pathology, Hackney offered an unparalleled choice, but most were much more interested in working at a grand teaching hospital. And while I was confronted from dawn to dusk with inequality and deprivation, I had no training in politics, philosophy or economics that would have helped me to analyse it."
She found her answers in a shift from more narrowly medical specialisms into public health, holding a succession of posts with health authorities, the Kings Fund and the Health Education Authority. "It gave me a means of articulating what I wanted to say," she says. "Public health forces you to be a bit of a jack-of-all-trades - there are elements of sociology, statistics, economics and other disciplines. It gave me a five-year training programme on top of my medical degree and the MSc I did at the London School of Hygiene."
From 1990, she also held academic posts in public health, first at UCL and then for six years at St George's hospital. Her stance as a critic derives from that grounding in science and public health rather than an overtly political outlook. "I was never politically active," she says. She rejects suggestions that she could be seen as a rebel or, as PFI supporters regularly suggest, ideologically driven.
She accepts that her work is inherently political, but in the sense defined by the great German doctor Rudolf Virchow (1821-1902), who wrote: "Medicine is a social science, and politics is nothing else but medicine on a large scale. Medicine, as a social science, as the science of human beings, has the obligation to point out problems and to attempt their theoretical solution: the politician, the practical anthropologist, must find the means for their actual solution."
For someone who has made herself unpopular with New Labour, one of her basic tests has a strongly Blairish sound - that popular refrain of the pragmatist, "does it work?". Kept firmly grounded in the reality of the health service by weekly attendance at UCLH Trust management board meetings, she says: "Our work is case-study based and highly empirical. It is all about evaluating what is going on on the ground from a public-health perspective: its impact on patients, staff and the wider population, and its relationship to the bigger picture."
One recent study looked at the problem of "delayed discharge" - where a patient, often old, is medically ready for release from hospital but continues to occupy a bed. "The government introduced a system for this that it claimed was imported from Sweden. Our evaluation shows that it is not working in anything like the same way," she says.
She dates her interest in PFI to 1990. "A banker I knew said, 'You should have a look at this. I've a hunch it will have a devastating impact on health'."
She was, she says, "initially agnostic about it", but rapidly concluded that the banker was right. Supporters of PFI, a Conservative initiative that has gathered pace under Labour, argue that it has enabled an unprecedented number of public projects by bringing in private capital and expertise while avoiding the huge cost overruns associated with public-only projects such as the Scottish parliament building.
Pollock does not agree. She argues that it is not about extra capital, but the structuring of debt. Because money is borrowed from the private sector, it is kept off the public sector borrowing requirement, "even though the National Audit Office argues that it should be there, because the risk is in reality the government's. It is a false economy, because government can borrow at lower interest rates than any private-sector institution."
Health authorities, she argues, have taken on PFI projects because they were the only way the government would allow them capital development. "We're back to Tina - There is no alternative - and, when faced with rising costs and interest demands that have a privileged claim on their resources, health authorities respond in the only way possible: by cutting beds and staff." She also argues that there has been a lack of public accountability. "This is a massive project that has created £35bn of new public debt and there has still been no proper evaluation of it," she says.
It is easy to see why she has upset New Labour. PFI, apparently offering the prospect of mutually beneficial public-private partnership, was naturally appealing to a party whose chief selling point in the mid- to late-1990s was that it was throwing off previous hostility to capitalism. It was a Labour MP with a background in hospital administration, Julia Drown, who insisted on the insertion of criticism of Pollock into a Commons health committee report.
At the same time, PFI was not, as a policy adopted from and still supported by the Conservatives, a partisan issue at the general election. Even so, Pollock's work has had a direct political impact: research from her group provided much of the factual ammunition used to propel independent Richard Taylor into parliament as MP for Wyre Forest in 2001, defeating a Labour health minister on the single issue of the downgrading of Kidderminster hospital. Taylor was re-elected last week.
And Pollock sees PFI in the context of broader debate over market models in the NHS. "One thing we know is that markets create winners and losers. In health this is done by squeezing services to people on the margins: the poor, the sick and the non-productive."
In particular, she is angered by the widespread use by the government of a paper claiming to show that American private providers Kaiser Permanente delivered healthcare more cheaply and efficiently than the NHS. Her group's rebuttal, published last year in the British Journal of General Practice, argued that the paper's methodology was spectacularly flawed. Political weight - government; the City, accountancy, law and construction firms involved in PFI; the US-government-backed drive by American healthcare companies to find overseas markets - will continue to count against her.
But the self-proclaimed bandmaster continues to argue that she has the better tunes. "Our arguments are based on evidence not assertion, and that's what makes them so angry. They have no response."
The CV
Name Allyson Pollock
Age "You can work it out from when I qualified"
Current job Professor of health policy and health services research, UCL and director of R&D, UCL Hospitals Trust
Soon to be Head of centre for international public health policy, Edinburgh University
Before that Posts in Edinburgh, Leeds and London; lecturer, UCL; consultant and senior lecturer, St George's hospital; Harkness fellow, University of California
Likes theatre, music, entertaining
Dislikes Pseudo-science
Married with two sons
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