THE Health Secretary and Darlington MP Mr Alan Milburn is a realist and a pragmatic politician. He will shrug off the predictable outcry from health service unions and some members of his party after his announcements this week about the role private hospitals may play in reducing waiting lists for treatment.

He knows most people who are ill and need treatment have no ideological problem over the nature of the treatment provider. They just want their operation - now.

He knows the capacity problems within the NHS cannot be overcome overnight. Despite the sums of money the Chancellor makes available to him, he cannot create beds and train/employ the number of doctors necessary to bring the waiting lists down and to keep Labour's promise on this fundamental election issue. He may also suspect, although probably wouldn't admit, that the NHS management has a proven record of not converting money into treatment as well as it might.

He is also knows there is capacity in the private sector. In his own constituency he has seen the building of a new private hospital with excellent facilities which could, under certain circumstances, make a big dent in the waiting lists for certain types of surgery. There are other, bigger, new private hospitals in the region more likely to do this - like the Nuffield at Washington. Whatever, there is plenty of capacity.

The problem is the political straitjacket the debate about the NHS takes place in whenever private sector involvement is raised. For many the idea cannot be entertained. Strangely, this is not a problem in Europe, where the private sector plays a significant role in public healthcare provision.

Mr Milburn knows he has a choice. Put all his money into the existing NHS monolith and hope it is translated efficiently into patient care. Or put a proportion into the private sector in the more certain belief that hips will be replaced, hernias fixed and heart operations completed - before the patient dies.