The man who'll make - or break - the NHS

ALAN Milburn is a curious mixture. He's a smoothie in a suit from darkest Tow Law. He talks deepest Durham - he actually speaks of "me mam" - but has calmed his vowels so he doesn't scare the softer south. He's a Blairite through and through and yet he sounds like an old-style socialist.

"The NHS is fundamentally about a belief that there is something bigger than ourselves, and that's the strength we get from working and co-operating with one another," he says. Or "Unity is Strength" as it once said on the banner of the Black Prince colliery where hundreds of Tow Law men once worked.

This mix means he is New Labour at his irreducible core. "Our health programme is quintessentially New Labour," he agrees. "If John Prescott was giving this interview he would say that it was about traditional values in a modern setting.

"The values of the NHS are more relevant than ever before. In 1948 when the NHS was formed it offered a pretty modest service. Now it is amazing. The sophistication of modern treatments is incredible and the cost is also incredible. It is only absolutely the very wealthiest people in society therefore who can possibly rely on their own resources.

"We don't know when we're going to get ill; we don't know what scale of help we're going to require so the best way to provide for people's healthcare and security is to pool the risk and have a big insurance policy. That's what the NHS is: an insurance policy but it doesn't come with any ifs or buts or small prints.

"You get the care according to the scale of your need and not of your wallet."

But being New Labour, he has no principles about where that care should come from.

"Where we can use the private sector, we should do so. If NHS patients can benefit, we should do so," he says. "Some people, including some in my own party, will find that very difficult, but in the end we will be judged not on where people have been treated but if they have been treated. If there are operations that can be done on NHS patients in a private hospital at a good deal for the taxpayer, that's what we should do. It's ludicrous to say otherwise. We have to end this stand-off between the public sector and the private sector."

Then, though, the mix becomes more curious still. He believes competition has to be increased within the NHS to drive up standards. Patients will be able to choose at which hospital they want to be treated. Competition, though, means winners and it means losers - but not if it is New Labour competition where everyone's a winner.

"We've got to get some incentives into the system," he says. "The Tories' internal market failed in the end because it didn't recognise that a town like Darlington has one hospital and it's not going to compete against itself so naked competition is not the right way to raise standards.

"But if you're doing well as a local hospital then you deserve some reward, and if you're doing less well you need some help, support and, where necessary, some intervention to put it right."

And Mr Milburn accepts that most patients don't really want a choice. They just want a good local hospital and a competent, friendly GP.

"But if people are being asked to wait 12 months for a life-saving operation at their local hospital when another hospital down the road could provide quicker treatment, then the patient should have a choice," he says.

So, from July, if you've been waiting up to six months for a heart operation, the local hospital will be in touch and the choice will be yours: do you want to wait a little bit longer locally or travel a bit further and get the operation done more quickly.

"Then we want to test whether we can offer that sort of choice for other conditions.

" I want to be in a position in three or four years when we have the computer system in place so that when a patient goes to a GP, the GP will be able to call up on the screen the different waiting times in different hospitals around the country for, say, eye surgery so you will have the choice: a hospital 20 miles away will do it in a week's time rather than the five weeks locally. That's a very different sort of health service."

This also begins to explain the other curious mix in New Labour's health policy: nationally-controlled standards but locally-administered delivery.

"In a national health system, it must be right that we have common high standards," he says, referring to the national frameworks for cancer and heart treatment and new organisations like the National Institute for Clinical Excellence which will dictate which drugs can be used.

"But the people who do the treating are the doctors, nurses and scientists - the people on the frontline. We want to give them the control over NHS budgets. We have set up 300 Primary Care Trusts run by local GPs, nurses and local appointed people and they'll decide how the budgets are spent and where the care is bought from.

"The power, resources and responsibilities are out there among the people who are really doing the treating and referring of patients.

"Now we've put the national framework in place, it is time for us to let go, to say 'here you go, there's quite a lot of money, use it to good effect'."

But then comes the cautionary bit. "It'd be dead easy for me to say that everything will be fine, but it is better to tell people the truth," he says, dampening expectations. "This is a system that for 30 or 40 years hasn't had money or reform, and it is going to take time - even with this level of resources to put it right."

Despite this, he knows that for both himself and the NHS, the stakes are high. If he doesn't show real delivery within a couple of years, he'll be out of a job; if the NHS doesn't show real improvement within four or five years, the Tories will be offering visions of a system that is financed by much more than just the state.

But Mr Milburn believes it goes further than that. "If we can get this to work, and I believe we can, I think it will change the nature of the whole debate that has gone on in this country and across the western world for the last 30 years," he says.

"That debate has been that somehow public spending is a bad thing. In the old way, when you ask people to put something in and not get anything out, it was. But we are saying put something else in and you will get something out: shorter waiting times more doctors, more nurses, better standards of care. It will change the whole political debate about the way public services work."

Or it will prove that they can't work.

"People care about health so much, that the stakes are always going to be high around it," he says.

"Every taxi I get into, people either talk about football or the health service. That can be a problem, because I get a lot of ear-ache. But on the other hand, I would worry if people didn't care about it - and they do, they care passionately."

It is make or break time for the NHS, for public services and Mr Milburn. And it is the ultimate test for the curious mix of principles and pragmatism that is New Labour.