It's never too early to set out your agenda. As election fever begins to take grip, Lyn Whitfield looks at who's backing who and at what could be in store for the health service

Alan Milburn is suffering from a nasty attack of political rheumatism.

'I can feel a general election campaign coming on - I can feel it in my bones, ' the health secretary told the House of Commons recently in a tetchy debate on the NHS.

When the election leaflets arrive and the election broadcasts start, Mr Milburn added, there will be a clear choice for voters. On the one hand, will be Labour's plans to 'modernise' and 'expand' the NHS. On the other, the Conservatives' plans to reform and expand the private sector.

With the battle lines drawn, the third main party in British politics is standing with Labour. One newspaper reported last week that the Liberal Democrats had agreed a 'pact' with the governing party on health.

Liberal Democrat health spokesman Nick Harvey laughs at the suggestion, telling HSJ The Times had 'put two and two together to make five'. But he confirms he was invited to take part in the modernisation process by Mr Milburn two weeks ago and that he attended a 'plenary' session of the modernisation action teams last week.

'We were happy to take part on the same basis as everybody else there - to have a discussion but to disagree if necessary, 'he said.

Pact or not, the Liberal Democrat submission to the national plan rejected 'the private sector-dominated vision proposed by the Conservative Party', because it would lead to a 'wider health lottery whereby the elderly, the poor and chronically sick would be left with a downgraded and overstretched 'last resort'' health service.'

It also accepted that the party 'welcomes much of the general direction of what the government is doing' with the support of NHS stakeholders.

Mr Harvey told the Commons that if the government had started earlier, 'the dividends would be starting to show.' But 'better late than never'.

In its 1997 manifesto, the party promised more spending, more doctors and nurses for the NHS, maximum six-month waiting times, a health and social care inspectorate, free eye and dental checks and a push on prevention.

Little of this conflicts with subsequent government policy, although Mr Harvey said the Liberal Democrats would not have given GPs a majority on primary care group boards or told the National Institute for Clinical Excellence to look at 'affordability'. The government, he said, should not 'hide behind' NICE when rationing decisions were being made.

He expects to oppose the government's response to the Royal Commission on Long Term Care if, as expected, it makes only 'nursing' care free, rather than the wider definition of 'personal' care. He also predicts a 'clash' with Labour over mental health and civil liberties. But overall, his party is happy to support Labour while it is fighting for an NHS in tune with its founding principles.

'The Tories recognise, with everybody else, that there is a lack of capacity, but they want anything on top of Labour's spending commitment to come from private insurance, 'he said.' We fundamentally disagree with that. We have no problem with using the private sector on the supply side, using spare capacity or NHS managers contracting where it is most effective, but we do not see a huge role for the private sector on the demand side through private insurance.'

Mr Harvey, who has represented North Devon since 1992 and was a candidate in the Liberal Democrats' last leadership campaign, is now working on policy in the run-up to the next general election.

This is likely to focus on further calls for more hospitals and staff - funded from taxation, although the details are not yet clear - a transparent and publicly accountable system and attempts to control demand.

In his speech to the NHS Confederation's conference in Glasgow last month, Mr Harvey said he would advocate a system of 'national health service guarantees', setting down the minimum standards of care patients could expect for every condition. He also called for a 'clear system' of prioritisation for patients on waiting lists, linked to a 'truly coordinated' system of referral between primary and secondary care, with clear protocols for referral and treatment.

Doctors, he said, had to make decisions 'in a manner that was not just fair in their own minds, but seen to be fair', and patients should leave their GP knowing if they are eligible for treatment, how long they have to wait and who to contact if something goes wrong.

On the attack: Milburn confronts the Conservatives Mr Milburn has been pursuing a two-pronged attack on the Opposition in press conferences and speeches over the past fortnight.

First, he has criticised the Conservatives' 'patient's guarantee' on waiting times for 'high-tech or expensive' treatment, saying it will lead to longer waiting times for nonurgent operations, pushing more people into the private sector. Second, he claims the Conservatives will actively encourage the expansion of the private sector through tax breaks for companies and individuals. In their defence, the Conservatives say they will match Labour's spending plans but expand private provision on top of this.

Shadow health secretary Dr Liam Fox also said it was 'ethically desirable' for employers to be encouraged to 'take an interest in the well being of their employees'.

But he said the patient's guarantee would be a catalyst for reform of the private sector because if people were guaranteed urgent treatment on the NHS there would not be a need for this to be included in insurance policies. Instead, insurance companies could offer more, but cheaper, products to cover other conditions.