- guardian.co.uk, Sunday 31 March 2002 02.11 BST
Firstly Whitehall is cutting the apron strings: from April 1, power over budgets and commissioning care will be handed over from local health authorities to primary care trusts made up of GPs. Critics say not all are ready for the responsibility, while others may make decisions with which Government is uncomfortable.
And secondly Gordon Brown is widely expected to come clean in the Budget on April 17 about the need to raise taxes to fund public services, a watershed for New Labour. If the money is not seen to deliver real change, taxpayers may revolt: but how long will it take to make a difference?
Health Secretary Alan Milburn spoke to The Observer about these central challenges for the NHS and the Labour Party. Here are extracts from the interview:
On funding the NHS
"We are in an absolutely crucial period now in the effort to improve the health service. There is going to be a big choice before the country and a big choice before the Government about where investment needs to go.
I think we have got to win three arguments: that the NHS is the right way forward for the country and the best way is an NHS funded through taxation - that is what Gordon was seeking to do in the speech he made last week tackling the argument that there is an easier or better way of funding healthcare.
Second, we have got to win the argument that if we put resources into the NHS we get results out. The most debilitating argument that our opponents try to put is that it can never deliver improvements but we have got to win the argument.
Third, we have got to demonstrate that the NHS is capable of being reformed as well as expanded. In the pubs and clubs of Darlington people don't use the phrase 'what people need is investment plus reform' but what people know is that the NHS needs change as much as it does extra money."
On private healthcare
"I think a lot of people feel like they are forced to go private, somebody with a bit of savings who might be in their 50s or early 60s, they have saved hard all their lives and they're suddenly told that they need a heart operation and they are faced with this terrible dilemma of either paying or waiting.
They have paid their taxes and what the NHS should be capable of doing is treating them for free."
On the Labour Party
"We should be proud of what we have done - reducing unemployment, providing more life chances - we should be proud of that, but in my view the Labour Party can't just be the party of the poor any more than it should be perceived as the party of big business.
What we have got to do is forge a national alliance behind Labour values. We are the party of the poor but we are the party of the aspirant too - that's what we got elected on in 1997, we have got to think about how we can make sure that the coalition of support is there today just as it was in 2001.
The NHS is a one nation service, it's got to be a service not just for the most dispossessed but that people want to positively opt for.
I think of people who are in their 30s, or 40s or 50s, they have got kids who are growing up and they're both working, they have got very busy lives and are under a lot of pressure, and they work very hard and they pay their taxes and what they want - actually more than anybody - is the train to be on time, the school to offer a high standard of education, the GP surgery and the hospital to offer a short waiting time."
On devolving power in the NHS
"The people who will be in control are the people who are treating patients and that must be right. The reform programme in the NHS is all about empowering frontline NHS services so they have the clout to improve services for patients. The time has come to let go.
Primary care trusts are in different stages of development. Some will do amazingly well really quickly, others less well. They are subject to the same regiume of assessment and accountability.
Am I expecting a lot of failures? No I'm not, but we have got to be prepared in a huge service like the NHS to say sometimes things are going to go wrong. There are going to be problems. I decided to take that risk. What I would expect to see is many more successes than failures."
