Controversial plans to bring private companies into the health service are the only way of securing the future of the NHS, the health secretary insisted today.
In a combative defence of the reforms, Patricia Hewitt maintained that the government was not privatising the NHS, but said that introducing more competition was vital to securing better services.
"The test is not who owns the organisation - public, private, or not-for-profit - but whether they can provide the best services for NHS patients. That is why there needs to be competition in the system," Ms Hewitt told a seminar hosted by the Institute for Public Policy Research, the thinktank which is closely linked to New Labour.
She also ruled out limits on the involvement of private companies in the NHS.
"We should not try and set arbitrary targets or limits on one provider or another. If independent providers can help the NHS provide even better care, we should use them."
Ms Hewitt conceded that "these are difficult times" for the NHS, but she added that services had to become "dramatically more efficient and effective".
Her speech came amid growing unrest within the heath service about the pace of reforms and closure of services, including accident and emergency units, to save money.
Hundreds of health workers are to stage a second nationwide strike during next week's Labour party conference, in a protest over jobs being "outsourced" to the private sector.
Workers at NHS Logistics are already set to strike for 24 hours from Thursday morning in the biggest outbreak of industrial unrest in the NHS for almost 20 years.
Barry Monk, a hospital doctor, has also announced that he is to stand for parliament in a marginal Labour seat over the threat of closure faced by Bedford hospital.
Ms Hewitt said: "It is hard for anyone to understand that after years of unprecedented investment, we are dealing with financial problems. After years of needing more staff, there are now job losses."
She claimed that the core values of a tax-funded NHS "free at the point of need" were "non-negotiable."
But she added: "The changes and reforms were are making are not only compatible with our traditional values, they are essential if we are to protect those values in a fast-changing world.
"Too often, when I meet staff who are transforming the care that patients receive, they are doing it despite the system - not because of it."
She added: "Are we privatising the NHS? Never. Are we changing the NHS? Absolutely."
Summing up, Ms Hewitt said: "The foundation values of the NHS are at stake here. If we fail, we open the way to those who are already saying that a tax-funded health service, free at the point of need, cannot survive in the face of modern challenges."
The shadow health secretary, Andrew Lansley, said: "If what Patricia Hewitt means by reform is local A&E services being shut down, up to 20,000 NHS staff losing their jobs, nurses who can't find employment, mapping NHS cuts for political gain and unprecedented deficits, then we don't want her reforms.
"Labour are trying to cover up for their failures in the name of reform. But it is their reforms that have flooded the NHS with incoherent and inconsistent policies and are responsible for constant upheaval."
Dr Beverly Malone, general secretary of the Royal College of Nursing, said: "We are not against reform... What we are for is reform that is tested and not going ahead without meaningful consultation with staff and the public...
"We must pause for breath, pilot reforms and talk to people about it. This headlong rush into reform is simply leaving disaffected staff in its wake, and risks giving people services they do not want."
