Patricia Hewitt: 'The Tories will be resurgent but we must deny them the middle ground'

Patricia Hewitt has been given mission impossible. The Prime Minister has handed the Health Secretary the task of improving the NHS and making the public believe that it is getting better. Billions of pounds have been pumped in, but so far the people remain sceptical.

Ms Hewitt is used to a fight. As Neil Kinnock's press officer and policy co-ordinator, she witnessed many bruising encounters. But now, Ms Hewitt, 56, says the Labour Government is at a crossroads and could make a "historic mistake" if it fails to modernise public services.

"We have been here before - and several of my cabinet colleagues were recalling when the Labour Party bottled out of industrial relations reform because it was too difficult or, in the 1970s, on council house sales when Labour failed to respond to working class aspirations to home ownership because for some reason - and I was on the wrong side of this argument at the time - we felt somehow that was betraying our values instead of recognising it was just the next stage of the advance of aspirations of working people. In both cases, change was delayed but it happened under Margaret Thatcher in a brutal way and it denied the more consensual approach to change that benefited Germany at the time.

"The centre ground is not a kind of pre-determined value-free zone that either we capture or the Tories capture. It is an area that you can stand on and take in a progressive direction as a Labour government or you can take in a regressive reactionary direction as a Conservative government. That is the measure of the importance of the debate that is now going on inside the Labour Party. The danger is if we get this wrong, we will be making a mistake of historic proportions," she adds, pausing for breath. "I wanted to get that off my chest."

Ms Hewitt believes the Government must face up to the challenge of renewing itself while in office. "If we think ahead to where we want to be by the end of the decade, we want New Labour to be renewed because the policies that were right in 1997 will not be right by 2010.

"We have never tried it before; we've always renewed in Opposition. We will be facing a Tory party that will want to claim the centre ground and present itself as an alternative. They will adopt the veneer of compassion; there will be a claim to competence to run things better and a new leader. We have to deny them the centre ground. We have to ensure that not only are we continuing to deliver a strong economy and better services but also, crucially, that we are transforming public services so that they are fair to everybody but personal to each.

"If we don't do reforms that will deliver the best possible health care, we will lose the argument for universal tax-funded health care free at the point of use; we will give up the centre ground to the Conservatives and public service reform will be taken forward, not by Labour in a progressive way, but in a different way by the Tories."

The Health Secretary is sitting in her office in Whitehall having just come from the Cabinet. She says she wants to win hearts and minds first.

"The feeling we all shared in the Cabinet was that we have to do more to involve backbenchers. It was partly about ensuring we explain policies better, but it's much more than that. It's about a genuine process of involving MPs who have the expertise of being rooted in their communities," she says.

She is the fourth in a line of Labour health secretaries, following Frank Dobson, Alan Milburn and John Reid, to propose a shake-up of the health service. This time, the focus is on altering the "family doctor" service, with a White Paper that she will publish "around the turn of year".

She is coy about the exact timing, because it is likely to be delayed until the new year to minimise the chances of a revolt. Labour backbench MPs such as Mr Dobson are lying in wait to knock the stuffing out her plans. Their main target is her proposal to allow more private companies to offer primary care services under the banner of "contestability", a New Labour euphemism for competition.

In The Guardian, Michael Meacher, a former minister, accused her of bringing back the Tory internal NHS market that Labour abolished on coming into office. Ms Hewitt is adamant she is not about to privatise the NHS, but says she has a job on her hands to convince the back benchers.

The White Paper will propose changes that mean patients will see a trained health professional in a walk-in clinic at weekends, but it may not be the family doctor. Nurses or others, perhaps even receptionists who have had medical training, will act as triage staff, passing the cases to others for treatment. To pay for it, more money will be switched from hospitals to primary care.

"This is one of the biggest challenges we face. We are doing too much in the acute hospitals and not enough in the community," she says. "If we are going to get excellence right across the board we have to imbed incentives in the system and payment by results is crucial because it will get each of our hospitals saying we have to get the best out of our surgeons and in many cases the hospitals aren't. They will have to change because they will not be able to go on with old inefficient wasteful ways of working.

"That is why the reforms we are making are essential because they will allow us to release funding from acute hospitals and transfer it into community services and new drugs like Herceptin [the breast cancer drug]."

More primary care services will be provided by private companies. However, Ms Hewitt says the notional 15 per cent ceiling on the use of private care by the NHS will not be broken before 2010.

She believes this is all good news for the patient, but she has an ideological battle looming with NHS staff and traditionalist Labour MPs, who see this as a threat to Labour's historic commitment to the NHS it created.

She had a foretaste of the rows to come when MPs attacked her at a meeting of the Parliamentary Labour Party last month over an order issued by Sir Nigel Crisp, the chief executive of the NHS, to primary care trusts that they were to change their role from providers to commissioners. It was a mishandling of the issue, raising the hackles of MPs who suspected it was a first step to handing NHS primary care to the private sector. It also raised questions about the fate of the NHS staff the trusts employed. Ms Hewitt was forced to beat a hasty retreat.

She was criticised behind her back for the cabinet row over smoking last month, and is in the awkward position of having to promote a Bill that she does not support. She believes a partial ban in pubs that sell food is not workable, and argued for a total ban, but lost in Cabinet. However, she may get her way, if the rebels defeat her Health Bill.

The daughter of a civil servant in Canberra, Australia, she came to Britain in the 1960s when she attended Newnham College, Cambridge, and gained a reputation as a fiery feminist. Melanie Phillips, the Daily Mail columnist, said of her: "One should never forget that, along with Solicitor General Harriet Harman, Ms Hewitt was a co-author in 1990 of The Family Way, a virulent anti-man tract which said that women had to work and become equal breadwinners within the family in order to give themselves independence from men."

As Minister for Women, she called on the organisers of the tennis tournament at Wimbledon to pay women players the same as men. She also said the rules of royal male progenitor should be changed so that Princess Anne should have an equal right to the throne.

Last week, she was consulting Labour MPs in groups on her White Paper, but there was a disappointing turn out of about 15 in each of two meetings. She is not put off. She will tackle MPs in one-to-one meetings. "We have got to do everything we possibly can to draw them in," she said.

She has been criticised for being too much of a technocrat, and too "nannying". It is certainly not the time to tell Labour MPs that "Nanny knows best".

The CV

* BORN 2 December 1948, in Canberra, Australia

* EDUCATION Church of England Grammar School, Canberra; Australian National University; and Newnham College, Cambridge

* CAREER 1971 Liberty and Age Concern

1983 Press officer for Neil Kinnock, Labour leader

1987 Policy co-ordinator to Neil Kinnock

1989 Deputy director, Institute for Public Policy Research

1994 Director of research, Andersen Consulting

1997 MP for Leicester West.

1998 Economic secretary to the Treasury

1999 Minister for small business 2001 Trade and Industry Secretary and Minister for Women

2005 Health Secretary