By Kampfner, John
New Statesman (1996) , Vol. 131, No. 4615
Relations between Gordon Brown and Alan Milburn are, once again, toxic. The Chancellor and Health Secretary are embroiled in a battle not lust over the provision of public services, but also the future of the Labour Party.
Brown is said to be still "hugely exercised" by the way Tony Blair's cohorts are trying to reinterpret the basic tenets of public service reform, using Milburn as a proxy. The Chancellor sees universal provision of healthcare being eroded by stealth and he is determined to resist it. He is even prepared to challenge what has been a given in new Labour discourse for almost a decade: that consumer choice is always a good thing, whatever the context.
The dispute over foundation hospitals, which burst into the open in July when Milburn revealed his battles with Brown in an NS interview, seemed to have been settled when the Prime Minister intervened in October. Blair secured a truce, but that was all.
In the next week or so, Milburn will publish a guide to the new type of hospital, which will be able to run itself, set its own pay rates, and borrow as much as it likes from private sources -- although, in the one concession to the Chancellor, Blair has agreed that all borrowing remain on the Department of Health's balance sheet.
Milburn's prospectus will fire the starting gun for a new National Health Service, moving unashamedly away from the 1948 settlement. In January, ten or 12 of the 46 "three-star" hospitals will be named as the first foundation trusts. By April 2003, they will be operating in shadow form -- even before the legislation has completed its passage through parliament -- and by April 2004 they will be fully operational.
Brown is waiting to see the detail. He is anxious not just about the ramifications for the health service, but for what the changes say about the government's priorities. He believes a single, one-tier NHS provides not only more equity, but also greater efficiency. He believes that the large injection of funds into health and education needs to be given time to work, rather than ministers constantly tinkering with structures. And he regards the emphasis on "consumer" choice as a superficial interpretation of the role of the public sector. At a recent cabinet meeting, he warned of the limits of the market in public services.
Brown believes offering choice to patients, while a perfectly reasonable aim in itself, is diverting attention from the main task -- bottom-up improvements across the board. "People want one good hospital, not a choice of three," says a government member close to Brown.
The battle over "choice" was obscured by the more public row about foundation hospitals. But during the Labour conference, I am told, it came to a head. Milburn had wanted to announce a major expansion of "patient choice" on the day of his conference appearance. Under a pilot scheme, which has been running since July, heart patients who have been waiting for more than six months are being allowed to choose where they want to be treated--within the NHS or privately.
Milburn announced that patients waiting for cataract surgery in London would be able to do the same. …