Patricia Hewitt set out the government's vision yesterday for permanent revolution in the NHS, with no limit on the role the private sector would play in provision of services to patients.
Two days before a national strike by Unison against contracting out the NHS supply agency, the health secretary said her blueprint did not amount to privatisation. But patients' expectations could not be met unless local NHS commissioners were free to choose private sector providers whenever they offered better value for money.
In a lecture to the Institute for Public Policy Research, she said: "Are we privatising the NHS? Never. Are we changing the NHS? Absolutely." It was not her job to decide which organisations should provide NHS services in five, 10 or 15 years time. The outcome would depend on the ingenuity of rival suppliers and the choices made by patients and doctors.
Her remarks caused anxiety among leaders of the medical professions. James Johnson, chairman of the BMA, said doctors were concerned about "an open door policy to the private sector" that could damage the interests of the most vulnerable patients. Beverly Malone, general secretary of the Royal College of Nursing, pleaded for a pause in the government's "headlong rush into reform" that had left staff disaffected and risked giving people services they did not want.
Further evidence of professional discontent came from a consultant dermatologist at Bedford hospital, who said he would stand for parliament at the next general election in protest at a threat to close it. Barry Monk said he hoped to repeat the success of the independent MP Richard Taylor, a consultant who took the Wyre Forest seat from a junior health minister in 2001 after campaigning against the downgrading of Kidderminster hospital. Mr Monk said he would stand in the Labour marginal Bedford and Kempston, where Labour had a 3,383 majority.
Ms Hewitt said NHS staff were facing a difficult time and there was "a sense that the service no longer knows where it is going". The answer would depend on decisions by primary care trusts (PCTs) and GPs commissioning services for their patients. "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 and value for patients, we should use them. If they can't we shouldn't," she said.
Ms Hewitt was asked whether this liberalised regime invalidated a forecast by her predecessor, John Reid, who said the private sector would not take more than 15% of the market for elective surgery in his political lifetime.
Ms Hewitt - aware of the rough ride she will get at the Labour conference in Manchester next week - said: "From everything I can see, I would say John's prediction was if anything on the high side."
The government did not want the NHS to become "a glorified insurance system buying services from the private sector" and would not be "just a logo to stick on the front door of a private hospital".
But the government could not say how much it would provide because that was for local commissioners to decide. Ministers would not organise a third wave of national contracts for independent treatment centres because PCTs could band together to buy whatever services they needed.
Ms Hewitt also signalled her support for David Nicholson, the NHS chief executive, who told the Guardian last week that up to 60 district general hospitals may lose A&E departments, paediatric and maternity services. Emergency care practitioners would treat more patients in their own homes or at the scene of an accident. The most serious cases would be handled in hospitals specialising in major trauma. But the NHS would still need A&E departments to handle the bulk of the work.
Ms Hewitt avoided saying how many may have to close. "The exact configuration must be determined locally by clinicians, ambulance staff and patients," she said.
