But he must learn lessons of Clarke's foray into 'competitive' marketplace

Published: 24/01/2002, Volume II2, No. 5789 Page 19

Ask any veteran manager who survived the internal market reforms to name their favourite health secretary and they will not hesitate: Kenneth Clarke. The minister who famously - in the words of the British Medical Association's propaganda campaign - refused to listen to medical advice, won managers' devotion by allowing them a generous measure of independence.

But, unlikely as it may seem, he could yet be ousted in the popularity stakes by Alan Milburn.

The arch control freak and manager-basher has travelled an astonishing distance politically since 1997. There could be no more forceful indicator of that than the condemnation of his old boss, Frank Dobson, last week in the House of Commons when Mr Milburn announced his proposals for foundation hospitals and 'external management teams' participating in franchising. The first of these has resounding echoes of Mr Clarke's initial ambitions for trusts, as outlined in the Conservatives' 1989 white paper, Working for Patients. The other (see below) could potentially open the NHS to a level of private sector provision about which the most freemarket Tories could only ever dream, even at the height of Mrs Thatcher's ascendancy.

How times have changed. Though details are as yet scant, the concept of foundation hospitals would appear to offer managers the kind of freedom for manoeuvre for which they have been pining ever since Mr Clarke left Richmond House. Unencumbered by stifling central directives and a plethora of targets, they would be left to use their pent-up initiative to achieve nationally set standards. The message preached by American management guru Paul Plsek last summer evidently fell on attentive ears.

So far, so good. But for five years ministers have been instilling a spirit of partnership and cooperation into the NHS and the other parts of the public sector to which it relates. Even the bornagain Mr Milburn would scarcely tolerate a return to the destructive pseudo-competitive antagonisms which occasionally flared in the early days of 'self-governing' trusts. When he starts to flesh out the details, it will be important to find a way of preserving fruitful alliances between institutions which may come to develop conflicting interests in his new-variant internal market.