Legacy of pugnacious minister who fought to modernise the health service

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Alan Milburn was a pugnacious Health Secretary capable of delivering a bloody nose to anyone who dared oppose him. He was also a passionate defender of the NHS which he believed had a great future - but only if its outdated practices were reformed.

His watchword was investment in return for modernisation. He secured the largest budget increases in the NHS's history. But he knew that unless the monolithic provider was turned round to put the needs of patients first, the project to save Labour's greatest creation would be doomed.

It began with the launch of the NHS plan in July 2000, an ambitious document that set new targets to cut waiting times, increase the number of doctors and nurses, and modernise heart, cancer and other services.

He presided over a huge expansion of the hospital building programme, funded by the private finance initiative (PFI).

Expanding the NHS was only half the story. Improving quality was crucial. After a spate of medical scandals, he launched the Commission for Health Improvement and a new system of clinical governance to ensure standards of medical care were checked. It was the first time that doctors had been held to account for their clinical decisions. The National Institute of Clinical Excellence was aimed at ending the postcode lottery that determined whether patients got the drugs they needed and at ensuring that the NHS received value for money from new treatments.

Improving access was an important issue. In addition to long hospital waits, there were difficulties for patients wanting to see their GP and for those awaiting the outcome of cancer tests. Work practice reforms were also crucial. New contracts were negotiated with the main staff groups but none has yet been implemented. Hospital consultants rejected their contract and GPs are being balloted on theirs.

Unlocking the stalemate with the consultants, on whom the Government depends for the delivery of its waiting-time targets, will be a priority for John Reid, Mr Milburn's replacement. But it was on foundation hospitals that Mr Milburn faced his toughest test. After a bruising encounter with Gordon Brown over borrowing rights, he was opposed by more than 100 Labour MPs anxious that they would increase inequity and reintroduce the worst elements of competition among hospitals.

The most important reform may be one that has received little notice until now - to give all patients choice over where they are treated by 2005. Increasing choice is seen as critical to persuading the electorate that a state-run health service is viable in 21st-century Britain. But delivering it will depend on more doctors, nurses and beds. That remains Labour's toughest test.