opinion : POLITICS

Stop right there. Pause the video. Rewind it a little. I think I've spotted what we were all looking for. Yes, there in Alan Milburn's speech to the NHS Confederation last Friday lurked his four-point definition of what the private sector will be called upon to do for the NHS.

This has been a problem since Tony Blair's 'no ideological barriers' speech at the launch of Labour's election manifesto in Birmingham, a document which also contained that phrase.Mr Milburn's clarification resolves it. Or is it merely a skirmish in a running battle with Number 10?

Confusion had been evident at two successive sessions of PM's question time in the Commons where William Hague - who actually did better than his one extra MP suggests - has harried Blair on the subject with some success.

'It does seem that the government's position now is that specially built surgical units can be managed by the private sector, but clinical services cannot be run by the private sector, and the PM has not explained the contradiction. No wonder he did not take Rory Bremner with him on his bus; he does different impressions of himself on a regular basis, ' the Tory leader quipped on 27 June.

Ouch! A week later, after Mr Blair had again been less than clear, Mr Hague said: 'Is it not time that he stopped facing both ways on this policy? He wants services to be managed by the private sector, but not run by private companies.'

Mr Milburn's confed speech in Manchester, the one where he dumped tricky negotiation of the new GP contract out of John Hutton's lap into theirs - all in the name of devolving power, so that even the Tories approve - appears to solve the problem.

The private sector will be used:

where its spare capacity, 'such as in private hospitals', can be used to do NHS operations;to get 'private-sector management to run the new stand-alone surgical centres', where they already have expertise;to 'extend public-private partnership cash beyond building new hospitals into 'primary care, social services and the provision of equipment';for it 'management expertise such as in the provision of IT systems'.

And car parks, I interject helpfully, since the secretary of state also cited parking during a campaign interview with me. I am assured that Mr Milburn has been trying to narrow down and refine what the campaign pledge means in practice.

After all, there is no point in being attacked by the unions for going 'too far' towards private-sector involvement in 2001 and then attacked from the other side in 2005 for not having gone as far as expected.

'Reassurance and realism' are hit watchwords.

But these are dangerous times for health ministers. As we all saw in Bournemouth, the BMA conference was both disillusioned and cross, its leadership running to catch up with an angry rank and file.

'Nothing so tricky to deal with as a trade union with weak leadership, ' Mr Milburn might murmur as he watches Dr Ian Bogle fulminating on TV. The consultants and the royal colleges are pussycats of co-operation by comparison.

This week's attempt to squeeze the lawyers' fees out of NHS compensation claims - now running at£400m a year - by reaching settlements without litigation will be less of a doddle. Having seen a 'Has doctor or nurse made you worse?' advert, handily placed outside one of his own local hospitals by a law firm, the secretary of state is determined to try.

But no one loves lawyers the way they (still) do medics. So the PPP controversy is politically more fraught.Has Milburn's Mancunian mantra drawn the boundaries clearly enough? The Tories are not so busy with their leadership contest that they are not watching carefully.

Acting on a tip-off, Liam Fox's deputy, Philip Hammond, asked Mr Milburn pre-Manchester if clinical staff in the elective surgical units are to be hired en bloc from a private-sector agency and thus employed by the NHS.

That would square the manage/run conundrum which so annoyed Mr Hague. Mr Milburn replied in terms of 'using the private sector where it is appropriate', but did not rule it out. The Manchester formula leaves that door ajar and Mr Hammond's suspicions still aflame that Richmond House and Number 10 are in conflict over just how far they want to go.