Mrs Beckett is armed and ready to do battle

In two weeks, Labour will announce its plans for the future of the NHS - some details are already emerging. It is make or break time for the shadow health secretary. Nicholas Timmins met her
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Labour has been powerful in condemning the Government's NHS reforms: competition has produced fragmentation; patients have faced a two-tier system; the Government's hidden agenda is privatisation, goes the litany of criticism.

But ask any of Labour's successive health spokespeople in the past five years what the party plans to do about the NHS and the verbal sparring begins. While Labour nationally damned the NHS reforms in the run-up to the 1992 general election, Labour councils locally were queuing up to be allowed to run the community care reforms.

And although plenty in Labour's ranks recognised the value of some government NHS reforms, notably the purchaser-provider split, overall,Labour saw the NHS as its territory. It believed all it had to do was claim it. The result was a document on Labour's health plans for the 1992 election that was a masterpiece of obfuscation.

Under David Blunkett, the argument moved on. His Health 2000 consultation document began to recognise the value of a divide between commissioning care and providing it. But furious semantic arguments remained about what that meant, and who would control the money.

It has fallen to Margaret Beckett, appointed to the Opposition health portfolio a year ago when Tony Blair became party leader, to deliver what Labour will actually do if it wins the next election. This week the first results of her deliberations have leaked. Full publication is due on 3 July.

Mrs Beckett's heart beats to many of the old Labour values. In conversation, her hostility to the private sector's involvement in health, and to the Government's private finance initiative in the NHS, is palpable. But she has always been a fiercely pragmatic politician, with a steely determination to deliver what is required of her. And much to some people's surprise, pragmatism has characterised her approach to health policy. "She has," one source said, "been very good and grown up about this."

This week, while declaring bluntly: "You can't turn the clock back, the old NHS does not exist," she was still fencing about Labour's plans, honouring the rules that say policy proposals are not policy until they have been through the national executive at the end of the month. But as the shape of Labour's package has become clear, it is evident that Labour does not plan a wholesale return to the old-style NHS.

The devil will be in the detail, but the thrust is clear. NHS Trusts will cease to own their own assets and will become part of a "single organisation" again. But they will retain their separate boards - reconstituted to include local councillors - and the separation between commissioning and providing will remain, though it will cease to be a statutory divide. All GPs - instead of just some - will be able to work with health authorities to commission hospital care. But GP fundholding, in which some family doctors directly handle the cash, will go. But Labour will explore moves that will still allow family doctors to switch money between drugs, treatment and perhaps even social care through "notional" budgets. Finally, the party will not impose a single model everywhere.

Indeed, Mrs Beckett is committed to experimenting to find the best ways locally of improving delivery of care. "The most criminally irresponsible thing that the Government has done is to insist on a single, dogma-driven blueprint about how things should be done, which, I absolutely believe, has the privatisation of general practice as well as the hospital service as its undeclared agenda."

Labour, she says, will attempt to avoid such dogma while insisting on the abolition of fundholding, which she maintains has brought two-tier care, destructive competition and huge expense, as well as the benefits that Labour wants to preserve.

The consultation exercise has left Mrs Beckett with a strong impression of a lack of common ground and consensus about what to put in place of the internal market. But, she asserts, "I do believe we have found solutions and they are viable."

And although she has encountered dissent, it has not, apparently, come from her leader's office. Tony Blair may be Labour's most radical post-war leader. But on the NHS his instincts are traditional. In his first party conference speech last year - the one in which he announced he was to ditch Clause IV - the passage on health was notably the most cautious.

The package to be launched next month will have Mr Blair's support. He is even quite happy to boast of "renationalising" the NHS - a word he would no longer use in any other context.

Since Mrs Beckett took on the health portfolio, she has been notable for her silence. Beckett vs Bottomley has not been much of a show. And this low-profile approach has won her few friends in the NHS. Even Labour supporters have been left wondering where the party is politically on health, fearing either that the baby would be thrown out with the bathwater, or that Mr Blair would simply swallow all the Tories' reforms. In our Harris poll this week, 43 per cent of voters said they did not believe, or were uncertain, that the NHS would be safe in Labour's hands.

That may be in part, Mrs Beckett concedes, "because people are not sure what the nature of our proposals will be". A little over a fortnight from now they will be. Battle will have been joined and Labour will discover whether its proposals to reform a reformed NHS still leave the health service as its natural vote-winning territory. How Labour emerges from that showdown may determine whether Mrs Beckett gets to drop "shadow" from her health secretary title if Labour wins the election.

Mrs Beckett is confident. The "co-operative rather than competitive" model that Labour proposes will appeal, she believes. And the Conservatives will be caught in a dilemma. "If we change anything at all [and Labour will], they will say we have destroyed everything they have achieved. And if we don't change everything [which Labour won't], they will say everything that they did was right. They won't know which way to jump."

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