The New Statesman Interview - Alan Milburn

He is mocked as Tony's puppet, but will the anger and impatience of the Secretary for Health change

Alan Milburn lives in interesting times. Health sector reform is the most visible, sensitive and difficult of all the tasks the government has set itself. The stakes are very high. Failure, as both Milburn and Tony Blair stress, could mean the end of the NHS as we know it and the arrival of real privatisation under some future Tory leader - and that would mean the final collapse of Labour's post-1945 world.

As for Milburn himself, he is (wrong side of the country, I know) the likely lad of new Labour, a bit rougher and more impetuous than most of the Blair Boys. He's no silver-tongued smoothie. I come away from the interview feeling I've done ten rounds in a boxing ring. There has been much finger-jabbing, and he ends each sentence with an ever so slightly menacing "OK?".

Perhaps it is not surprising that he is not all honeyed charm on the day we meet. The public-private partnership row has broken out more violently on his patch than almost anywhere else. I, like many other journalists, have written recently about ghastly experiences in the NHS; about the insanity of trying to drive change in the system without taking the workers with you, and - yes, OK - I have also called Milburn a "quiescent Blairite".

For his part, Milburn has been trying desperately to tone down the hype of the past few months about just how far the government does plan to involve the private sector. So much so that he has been praised by the Mirror recently, under the heading "That's more like Labour". So just what is going on here? Has the ultimate Blairite turned traditional? It's a suggestion that Milburn is quick to rebut: "I don't think anyone is going to write about me that I'm not a reformer." Well, yes, a reformer, but with a distinctly old Labour heart. In a recent speech to NHS managers, Milburn tried to quash comprehensively the idea that the government is fostering the creeping privatisation of the service.

Private involvement is to be limited to the fringes, the periphery, with IT systems and surgery or clinic buildings the main recipients of private expertise. NHS patients will take up some spare capacity in private hospitals. Private service managers will run certain specialist surgery clinics - for example, those designed to cut waiting lists for hip operations.

But, all in all, this is not mass privatisation of the NHS. So Milburn has been saying for the past few weeks, and so, he insists, has everyone in the government. OK? Well, all right. But if so, why have the public and the unions got the impression that the private sector is to play a major role in reforming the public services?

Milburn is determined not to sound as though he's picking a fight with the Prime Minister, but it is clear from what he says that he thinks the rhetoric some new Labour spinners have been using has gone a bit too far: he sees the need for putting "boundaries around where public and private begin and end". Boundaries, I suggest, which were perhaps not in evidence during the last election campaign, when the ideas were initially floated?

Milburn concedes that the government appeared to enter into "open-ended commitments" about the involvement of the private sector. What that does, he believes, is "allow the conspiracy theorists on the far left to interpret your policy for you, and the free marketers on the right to claim that our policy is their policy. And, as it happens, neither is right."

He is quite happy to draw lines around where the private sector's involvement begins and ends, but admits there is a "clear danger" that people will then "write this up as a U-turn". It is as near an admission of error as we are likely to get.

Milburn's language in defence of the NHS and the public service ethos is uncompromising: "Public sector reform is not primarily about involving the private sector in public services," he insists. For him, what matters is the commitment to public services: "People like me are pretty wedded to the public service ethos," he enthuses. "We believe in it, and we believe in the people who work in the health service." It's essential to preserve this ethos "at all costs", he says, because "it represents our values".

The trade unionists and public sector workers who have felt themselves under the cosh from what Blair has been saying will be relieved to hear that. But how does what Milburn says square with the Prime Minister's speech of 16 July, which mingled reassurance with a touch of menace? Milburn insists there is no difference: Blair, he claims, has "gone out of his way to say that doctors and nurses are doing a fantastic job".

The government is trying to support them, the Health Secretary says, "through a tremendous process of change", yet he sees the change as coming from within, rather than outside the health service: "For me, public service reform has got to come from within the public services, for self-evident reasons . . . The NHS is a virtual monopoly provider. It's absurd to suggest that expertise and knowledge are housed anywhere other than in the NHS."

Despite all this reassurance from Milburn, there remain loud rumblings from the trade unions, not to mention back-bench Labour MPs. I ask what he thinks is causing this mood. He ascribes it partly to "post-election fatigue - I'm knackered, everyone's knackered, everyone needs a holiday"; but he admits that "there is clearly something deeper" than just tiredness.

The answer to the government's present problems, he believes, lies in greater debate and openness. "I think we should be more confident about sharing with the public some of the difficulties and dilemmas of what we're trying to do, and get into a dialogue and a discussion, rather than just an exhortation or, dare I say it, spinning our way through the second term."

Open dialogue? Not relying on spin? It's not exactly new Labour. I ask what he thinks of his media caricature as a toadying Blairite. "To tell you the truth, I couldn't give a **** about that, I really don't care about it," he blazes. This leads into a fierce attack on the media, which like to label Labour politicians as left- or right-wing, old or new Labour. "It's easy to say that you are for traditional values or that you are for reform. What a load of complete and utter tosh. I am genuinely not bothered about labels. The public don't care about labels, actually; what they care about is public services working." I ask if he is this spiky in cabinet, and he replies with withering sarcasm: "I have been known to say one or two things, but obviously, as a Blairite puppet, I do whatever Tony tells me . . . Obviously, I do his bidding."

Ouch. And I am not off the hook yet. I am, it seems, one of those journalists who are "unrelentingly negative" about the NHS - the one thing that Milburn admits gets him down about his job. Condemning the "daily outpouring of bile", he asks why we never read about "good news" stories in the press, such as the group of clinicians and managers he has been working with who have managed to get waiting times for cancer patients who need radiology down by 60 per cent. "It doesn't make it perfect, but for those cancer patients, it really is important," he says. Well there you are then.

Shining through his attack on the critics in the press is a genuine respect for public sector workers. He praises the people who work in the health service, who came into it knowing that they won't "make a mint", but who "care for others; it's terribly old-fashioned and romantic, but it happens to be true," he insists.

Milburn is passionately in favour of the devolution of power, not just in the health service, but also to local government. "I believe we will get more public service reform out of devolving power in the NHS - that's where we should be confident, we should have the confidence to let go. We should have the confidence to believe that Whitehall doesn't always know best [and] that, in local communities, there is all sorts of knowledge."

Letting go is something new Labour has found notoriously difficult to do, so how is the process to work this time? For Milburn, the big agenda for Labour's second term is to get power "out there, down there, so that the ordinary ward sister, the ordinary hospital consultant, the ordinary GP really feel that they've got a hand in shaping this". What about the rest of us, the users? He wants small changes, as well as major ones, that could make a real difference for patients, such as changing the appointments system in hospitals. "Everyone gets told to turn up at two o'clock and, amazingly, they're pretty pissed off by five o'clock when they haven't been seen. So why don't we just structure the appointments at 2.10pm, 2.20 and so on? . . It's a simple thing to do; it just means changing the thinking."

But not everything he has to do is simple. Milburn faces an enormous task over the next four years, and he knows it. "If we're going to save these public services and make them relevant, if we're going to make them as good as the public want them to be - and boy, we had better do that, because the stakes are pretty high . . . then you've got to harness their values and you've got to reform their practices."

Is he confident he can do it, that he can make a difference? Yes, he replies: "We are on a journey, and the journey is going to take us ten years, and we have got to have the confidence and the guts to say that we are not going to turn it round overnight." The Health Secretary believes he has the right reforms in progress; and argues that, objectively, things will get better, have got better, but admits that, "subjectively, there isn't a huge warm glow".

No, there isn't. Nor is there any certainty that there will be in ten years' time. Milburn has a rough tongue and a capacity for speaking the truth. Yet, rather to my surprise, I come away thinking more of the man. His pro-NHS instincts, but also his impatience and his anger, may be just what we need.