OPINION

Two weeks into the election campaign, you could hardly blame the one in three members of the Royal College of Nursing who gloomily told their eve-of-conference survey that they do not expect the NHS to remain free at the point of delivery in 10 years' time.

I should say right away that in the past week I have asked Alan Milburn, Alastair Campbell and assorted spin paramedics that question. On the day that Sharron Storer's outburst over cancer delays pushed Labour's manifesto launch out of the headlines (and John Prescott's left jab did the same to her), the BBC's Andy Marr asked Tony Blair too.

The NHS will remain true to Nye Bevan's first principle - taxpayer-funded and free to users - they all replied. The insurance option is ruled out. What's your model system for reform, I asked Ally Campbell. French?

Canadian? Kiwi? 'The British model, ' the patriot replied. But things are moving fast when you consider it was only last summer that the NHS plan introduced the 'concordat' with the private sector - a huge, symbolic concession by Labour at the time. The logic of partnership looks relentless to Number 10.

Thus, when on manifesto day last week my colleague at The Guardian, Patrick Wintour, unearthed that Institute for Public Policy Research think-tank report on the need for more private contractors to run more of the public education and health systems, I expected trouble from the Labour heavies at Millbank.

But the heavies did not denounce the IPPR work. They merely said they didn't agree with all of it - with private sector district general hospitals, for instance. Private specialist clinics?

Probably OK. It is clear that when Mr Blair said in Birmingham there should be 'no ideological bar' to efficient and reformed schools and hospitals he meant great swathes of private management. Not just those 64 PFI hospital-building schemes (many still searching for a willing private partner), but the buying-in of services. The Sunday Times claimed that ministers are negotiating to buy£1. 5bn worth of operations - 1 million compared with 100,000 now.

Most clinical staff will remain NHS employees or contractors, and buried away on page 34 of Labour's manifesto is a promise to the ancillary staff that publicprivate partnerships should 'be on the basis of best value, not worst labour standards'.

That translates as meaning that anyone transferred to a private employer would remain under protected terms of employment, the so-called TUPE regulations - 'still part of the NHS family', as my Milburnite source explains.

It is not all one-way traffic. My notebook records a Number 10 man saying, 'We can learn from good private sector management and good public sector management. Good hospitals drive out bad ones. We want the best management to take forward overall reform of the system. '

That is the thinking behind the University of the NHS - one of the few new ideas in the manifesto that got overlooked - along with cheap mortgages for nurses and reform of fast-rising clinical negligence settlements.

My guess is that we are going to see more managers moving in and out of the public sector, certainly good ones moving out to set up companies to bid for 'soft facility management' of all sorts of purchaser and provider functions.

NHS reform will not be cheap. Hence Blair's stress in a keynote speech in Kent on Monday that only investment-and-reform will make the NHS a 'service of first choice, rather than last resort'.

Fortunately, that chimes with the public mood, which is why Labour will get its second term - to deliver. Oliver Letwin, the Tory MP who admitted telling the FT about£20bn worth of annual spending cuts by 2006, accidentally made the point. Voters didn't believe his sums and do not want the money back. They want clean, efficient hospitals - or else.