What a discordant clutch of messages to have emerged from the government's Queen's speech programme. Not the health bill to devolve power and financial control towards NHS frontline forces - that barely got a look in.

No, it was the involvement of private sector capital and management which provoked what looks like becoming the crucial test of Alan Milburn's political skills and leadership. No wonder he went on the offensive on Monday to stress that the NHS is 'not up for sale'.

Will that be enough? Or did ministers - led by T. Blair himself - fatally mishandle the message during the election campaign so that teachers and health staff really think their schools and hospitals are going to be 'sold' to people who (Mr Milburn admits) lack the expertise to run them.

Unison is still threatening an historic breach with Labour, while the Institute for Public Policy Research's much-leaked report supports the use of private management skills, but seriously challenges the private finance initiative for hospitals.

There is no reason to think it need damage the interests of Unison members, IPPR's super-cool director Matthew Taylor argues, though you have to watch morale - as the disastrous outsourcing of NHS cleaning and catering showed.

His believes the private sector can run prisons, roads and some council services - but hospitals?

'We would not argue. . . that the private sector can take over the running of hospitals and employ doctors and nurses, not because of any ideological objection but because there is not any evidence that it will succeed, ' he says.

He calls the government's signals 'confusing', and I agree - though not as confusing as Claire Rayner's message when trying to explain why, as president of the Patients Association, she went private for her double mastectomy. 'I do not share my body with strangers when I am well and I am buggered if I'll do it when I am ill, ' Aunty Claire explained guiltily. She was desperate for a private room. Fair enough: she would have been chattered at all day by well-meaning fellowpatients.

The confusion arose when Ms Rayner told Radio 4: 'If everyone put in a fiver a head we can have the NHS everyone wants. ' Well, er, yes, a fiver a head would yield£300m maximum. What she really meant was higher taxes.

Revolting Lord Roy Hattersley would say the same. Mr Blair says that will not work without greater efficiency. They are both right.

But the confusion is not all onesided. I lunched last week at a Conservative think-tank where the muddle was every bit as evident. One Oxbridge don wittily explained that people believe the NHS is more moral to back a system where they will be spared life-and-death choices based on ability to pay - 'though of course it doesn't spare them'.

We all smiled in a sophisticated way, as we did when a professor explained (several times) that his American university insurance scheme covers his whole family for less than the NHS spends per head. He stubbornly refused to admit flaws in his logic: to get the state out of healthcare altogether.

Which shows how foolish professors can be.

No one may have copied the NHS model, but no one follows the US model either.

Interestingly, my right-wing pointy-heads, though tending to Euro-scepticism, are much more interested in the EU mixed models (as are most candidates for the Tory leadership).

The British, French and German governments all spend about 6 per cent of GNP on healthcare, exp-lained one medical peer.

The difference is that the private sector generates 2 to 4 per cent on top of that in muchadmired France. My free-market friends think that is where we are headed, but they did have the grace to laugh at the British private health sector.

'They do not believe in the free market either. They'd much prefer to fix the market price, ' said one medic, chuckling over routine attempts by health insurers to over-pay him for routine operations on which they had already overcharged.