The big trade unions last night inflicted a sharp defeat on the government's plans to expand the role of the private sector in the NHS despite a plea from the health secretary, Patricia Hewitt, that it was vital to achieving shorter waiting lists and a better service.
An impassioned debate at Labour's Brighton conference saw Dave Prentis, general secretary of Unison, the biggest NHS union, pitted against Ms Hewitt. He argued that ministers have persistently failed to consult patients, NHS staff and even MPs over "fundamental changes" that threaten to fragment the service and reintroduce "destructive markets and competition" into the system.
Results of a card vote will not be announced until this morning, but the arithmetic made it impossible for the government side to win. Ministers hoped that a majority of constituency delegates would support them.
The health secretary will not moderate her policies as a result of the vote, claiming she has support in the constituency parties for radical reform. But she promised to consult more and provide protection for any staff transferred into the private sector.
It was the second defeat of the week for the government, after a vote on Monday to restore the right to take secondary strike action, lost under the Tories. A third defeat followed when the conference overwhelmingly endorsed a GMB union motion calling for the pension age to be kept at 60 for public sector workers and linked to earnings.
The conference itself was divided during the health debate. Ms Hewitt was backed by delegates who argued that the latest round of private sector contracts was signalled in Labour's May 5 manifesto and in the Warwick agreement with the unions in 2004. At stake were a Unison-inspired composite motion which urged suspension of new private sector contracts pending "an urgent joint review" of their role - now being expanded into primary care jobs and functions - versus a more pro-government alternative which welcomed the expansion of "choice" for patients and the private sector's contribution to NHS reform.
Coincidentally, the alarm of the conference that jobs may be at risk from the twin pressures of private contracts and budget overspends was reinforced last night when Oxfordshire Mental Healthcare trust suggested that seven consultant posts are at risk because of cash shortages. Seven junior doctor posts are also unlikely to be filled next year as the trust makes £5.9m reductions, equivalent to 10% of the costs of its services. The trust has balanced its books for the past five years but has been told it must contribute to saving NHS money across the region as well.
Throughout this week Ms Hewitt has rejected alarm over NHS trust cash deficits. "By and large the deficits are in wealthier parts of the country, the underspends are in poorer areas." That inequality must be changed, Ms Hewitt said.
Mr Prentis, echoing a term from Tony Blair's speech on Tuesday, described NHS staff as the real "changemakers" of the health service. Yet health visitors, community midwives and district nurses were threatened with transfer to the private sector. "We are told that the NHS has to be fragmented - hospitals competing for patients. And if an NHS hospital can't compete it will close."
Ms Hewitt quoted from the Warwick accord supporting the extension of patient choice and approving the use of spare capacity in the private sector to reduce waiting lists. She promised to protect the rights of workers who were switched from NHS to independent employers.
She said the NHS had always made use of the private sector, not least the pharmaceutical industry. "Haven't we learned that profits are not a dirty word? They are part of a dynamic economy and they are helping build 100 new hospitals as well ...
"People in pain and anxiety are still being told by our NHS to wait months, sometimes years, for an MRI scan. But if they are able to go private they can have it done in a day. That is not acceptable."
