Private sector's involvement in the NHS has no limit, says Hewitt

Patricia Hewitt, the Health Secretary, has said there should be no limit to the involvement of the private sector in the NHS.

Ms Hewitt's remarks risk exacerbating a threatened strike by health unions angry over the award of a contract for the delivery of hospital supplies to the private firm, DHL.

She will use a speech to the left-leaning think-tank, the Institute for Public Policy Research (IPPR), tomorrow to make it clear there will be no turning back on thereforms, and that she was "fighting for the soul of the NHS". She said she had reviewed the limit of 15 per cent suggested by her predecessor, John Reid, on the use of the private sector to carry out elective surgery - non-emergency operations - for NHS patients.

"Even after we complete the current private sector procurement it is looking at about 7 or 8 per cent of elective but these decisions, in my view, shouldn't be made by the secretary of state," she said. "They should be made by patients."

Her comments came as a senior Labour figure revealed that Tony Blair would try to use a cabinet meeting on Wednesday to bind Gordon Brown and ministers to a reforming agenda after he leaves office. Mr Blair will set up working parties to report back within three months on the economy, public service reform, security and immigration, terrorism, aid, climate change and reform of the United Nations.

Mrs Hewitt is widely seen to be leading the fight on Mr Blair's behalf but has made it clear Gordon Brown would also deliver the controversial changes to the NHS.

She also made it plain that she would stand up to the critics threatening to protest at the party conference about cuts in hospital accident and emergency units or general surgery wards. "These aren't cuts. This is a better service," she said. "We must take account of modern nursing practices to look after patients in their own homes. For certain types of treatment you need to go to a specialist centre. If you get breast cancer you do not want to be operated on by a surgeon who has done some breast cancer operations but has spent most of his time on general surgery. You want a specialist surgeon. The idea that all this is cuts is simply wrong."

She added: "If this Labour government under Tony Blair or the next prime minister says the change is too difficult and backs down, then we will open the door to top-up payments and the unfairness of the American [insurance] system."

With the big increases in spending on the NHS coming to an end in 2008, Ms Hewitt warned that the NHS would have to live within its means. "We are six years into a 10-year programme which has always been billed as investment and reform," she said. "Everyone loves the investment. Not everyone loves the reform. There is a weariness with change and, because of the financial problems coming on top of the change, there are a lot of people who have real questions about where we are going. We have got to respond to that, perhaps better than we have in the past."