- guardian.co.uk, Sunday February 16 2003 09.22 GMT
At a private meeting with the country's top hospital and primary care trust chief executives last week he spoke candidly about a series of problems which no government Minister has ever publicly dared acknowledge.
He told the chief executives that taxpayers were highly sceptical about the reforms, that waiting lists were going to be lengthy for some time, and that plans to extend choice to patients were a 'huge lottery'.
Milburn also made it clear that it would be 'politically undeliverable' for him to close any hospital, despite arguments from senior doctors and the medical royal colleges that this will be necessary to provide safer emergency cover and specialist care.
But he did not rule out charging patients who fail to keep hospital appointments, although he said it would be impossible to penalise them at the moment, given the long waits for treatment.
His remarks are bound to ignite the row over whether the Government is being honest about the pace of the health reforms. Tony Blair has made it one of his key pledges that he will rapidly cut waiting lists and modernise run-down public ser vices by recruiting thousands of extra staff and creating foundation hospitals.
But the real size of the problems were spelt out by Milburn at the Queen Elizabeth II Conference Centre in Westminster last Tuesday. Journalists were asked to leave after they had listened to the Health Secretary deliver a glowingly positive view of the Government's plans to extend patient choice. However, The Observer remained incognito and heard him give a worrying assessment of the situation.
'My biggest worry is that we end up putting taxes up and, make no mistake, come April, there will be one hell of a lather about taxes rising,' he said. 'Every poll will tell you one thing - people like the idea, in principle, of paying more to get more out of the NHS. The problem is when it starts hitting people in the pocket. There is quite a lot of scepticism about the way the NHS is capable of transferring these biggest resources ever into results for patients.
'Many people will conclude, "Well, that's great, and they have tried it, but actually it isn't working," If people feel the NHS isn't part of the world in which they live, why should they bother?' It was their job, Milburn concluded, to try and show people it would produce a different kind of health service.
Milburn's comments contrast hugely with the upbeat messages about the reforms and investment being put out by the Government, just six weeks before National Insurance contributions rise by 1 per cent at the beginning of April.
There is growing nervousness that the public remains to be convinced by the 7.4 per cent spending increases, in real terms, which Gordon Brown earmarked for the NHS for each of the next five years. This will see spending rise from £65 billion this year to £105bn by 2007.
The latest waiting list figures show that the number of patients waiting more than 12 months has fallen by some 20,500 compared with last year, and that waits for outpatient appointments are also falling.
But Milburn voiced concern when he told delegates: 'We are going to have relatively long waits for some time to go - 12 months and then nine, which, particularly for a more serious thing [condition], is a long time for people.'
He said there were risks with the Patient Choice project which Blair announced two weeks ago, which will see patients who have waited more than six months for particular operations being rung up and offered speedier treatment at an alternative hospital. He said they were going to have to learn from different schemes being implemented across Britain to see how it would work. 'We will need to change the mindset of GPs and how they refer [patients],' he told the chief executives. 'It will not be the old order. For me, it is a huge lottery.'
But a Department of Health spokesman said Milburn meant that the current system is a huge lottery, with people being stuck waiting different amounts of time for operations - not that the plans for the service are an experiment. He added that the Health Secretary had been explaining to the chief executives that no one could afford to sit on their laurels because there was a lot of work to be done reducing the waiting lists.
Tory health spokesman Liam Fox said Milburn's comments reflected the Government's state of desperation over the NHS.
'Doctors know that it isn't working, patients know it isn't working and now the Health Secretary is beginning to recognise this,' said Fox. 'The changes may be a lottery for patients, but they're an even bigger lottery as far as his career is concerned.'
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