NHS chief executive Sir Alan Langlands has given the clearest signal yet that the comprehensive spending review led by the Treasury, which is due out next week, will rule out charging at the point of access for any NHS services.
Deviating from his prepared speech, Sir Alan gave a personal pledge that he would follow the example of Nye Bevan and resign if the founding principles of the NHS were challenged.
'Fair access includes treatment on the basis of need, not ability to pay. Bevan resigned in his determination to stand by this principle, and I think I would do the same. For 50 years it has been a pillar on which public support for the NHS has rested,' Sir Alan said.
'Operating a system where those who can pay get a better service will erode this pillar of support and goodwill like nothing else.
'Arguments in favour of charging don't wash - how could we talk credibly about the NHS playing its part to reduce inequalities in health, if at the same time we are challenging the ambition of equal access to healthcare?
'Let's not waste any more time on this discussion - the direction has been set by a democratically elected government and that is good enough for me.'
Sir Alan said the rebuilding of the NHS was underpinned by three supporting strategies: money - from the comprehensive spending review; the information management and technology strategy; and the human resources strategy.
'We can't deliver 100 per cent reform for less than 100 per cent investment. We have to make sure that the whole of the revenue budget works for transformation, not just using the money announced (by Tony Blair) yesterday but for the pounds 35bn.'
Evidently mindful of the fact that he received a tough time giving evidence to the Commons public accounts committee over the failures of key IT strategies, Sir Alan said it was the issue that 'we have got to crack'.
'This is an issue that I will give most personal attention in the year ahead.'
Sir Alan backed the vision of a new NHS set out by Mr Blair and said change would come by 'repositioning the NHS away from the old institutions and professional groupings and putting people who use it centre stage'.