Milburn and Clarke take on Brown over reforms

Alan Milburn, the Secretary of State for Health, yesterday attacked as "patronising nonsense" claims from his critics that the poor would suffer from a radical extension of choice in public services.

In what appeared to be a direct challenge to the Chancellor, Mr Milburn teamed up with Charles Clarke, the Secretary of State for Education, to outline their vision of ultra-Blairite health and education reforms.

The two Cabinet ministers gave the clearest demonstration yet of an alternative power bloc to Gordon Brown with a rare joint press conference organised by Downing Street. Both have recently had well publicised disputes with Mr Brown over their respective plans for NHS foundation hospitals and "top up" student tuition fees.

Their joint appearance came as Mr Milburn set out revolutionary plans to give the choice of an alternative hospital to an extra 100,000 patients who have faced long waits for surgery.

A current scheme to give such choice to heart patients who have been waiting six months or more and cataract patients in London will be extended to new treatments and parts of the country. From summer next year all patients waiting six months for any form of elective surgery would be able to choose to go for treatment instead at at least one alternative hospital and normally four public or private hospitals or Diagnostic & Treatment Centres.

Most radical of all, all patients would be offered by December 2005 an alternative choice of hospital, including private ones, at the point of GP referral.

Some Labour MPs have attacked the idea of greater choice in the NHS as a Tory idea that would lead to "two-tier" services and last week the Chancellor set out his own limits to the use of the market.

In a speech to NHS chief executives, Mr Milburn said: "Some say poorer people do not want to exercise choice or are not able to do so. I disagree profoundly. That is patronising nonsense."

The Health Secretary later specifically rejected Mr Brown's twin criticisms that patients were ill-informed to make their real choices about healthcare and that hospitals are "natural local monopolies".

"We are in a consumer age whether people like it or not. What will destroy the public services is the idea that you can retain the ethos of the 1940s in the 21st century," Mr Milburn said.

He flatly contradicted the Chancellor's claim that patients lacked knowledge to make choices. "It isn't true in my view, particularly when we live in this informed and more enquiring world where the internet is redistributing knowledge as never before, that patients don't know things," he said.

Mr Milburn said that the only practical limit on the market in the NHS was one of capacity both of the public and private providers. When asked specifically about the idea of a hospital having a monopoly in its local area, he replied: "Nobody has a God-given right, in politics or anywhere else, to be. You have to earn that right.

"The one-size-fits-all approach belongs to the last century. That is why both Charles and I believe that when it comes to reform our foot should be on the accelerator not the brake."

Mr Milburn said that choice would drive up standards as well as "completely changing" the relationship between patients and the service they received. "The services exists for one reason and that is to serve the patient".

The Health Secretary also rejected the idea that foundation hospitals would create a "two-tier" health service because under his plans all trusts will be eligible for the new status.

Mr Clarke said that he wanted "to encourage the best with more freedom and autonomy" and praised Mr Milburn's foundation hospitals idea as an excellent means of doing so.

Both men were dismissive of Tory claims that government spending will reach more than £50m an hour in April.