Prime minister outlines limits of state intervention in healthcare

The hall of the Djanogly City Academy in Nottingham is a perfect Blairite space - a postmodern steel-framed rectangle built by local philanthropist Harry Djanogly, who made his fortune in the textile industry.

There are posters on the walls with encouraging quotes about duty and - this is a key phrase that will recur - personal responsibility.

It was against this backdrop in front of a selected audience of around 50 Labour Party activists and local health and community workers that the prime minister kicked off the first of a round of over 100 Let's Talk sessions which it is hoped will develop and carry forward new policies.

Some were describing today's launch, and the next day's speech, also in Nottingham, as foretelling the end of the nanny state.

But that seems wide of the mark. Mr Blair said his government can and will make laws to curb the excesses of the tobacco, food and drinks industries whose products make us unwell. It can regulate and create structures. But it can only do so much. You must change your lifestyles to ease the burden on of diabetes, smoking and alcohol abuse.

And if that doesn't happen? 'If we are in a position where we are still carrying those costs at a time when healthcare becomes more expensive, more treatments are available, people are living longer, we have got a serious crunch coming in policy further down the line.'

New Labour, new nanny?

So nanny is still there but she seems to be disguised as a young slim Blairite puritan extolling the virtues of exercise, moderation and 'responsibility' for everyone.

He said: 'The old concept of a sort of infrastructure health service that the state delivers to people in a traditional way doesn't really meet the challenge of public health today, whether it's alcohol abuse, or smoking or obesity or how we have a more balanced lifestyle, that means at a later time we are less likely to be a strain on the NHS.'

He said he wanted to see charities providing more health services: 'Sometimes you want the state to be less; there is a lot more today that can be done at a voluntary or community level. I don't think we make nearly enough of, or fund clearly enough, voluntary and community activity which makes a huge difference to people's lives.'

Sometimes, he said, the state would get out of provision, but it would also go into areas where it felt necessary such as smoking and banning advertising on unhealthy sweets and snacks for children.

As the limousines whipped the PM and his entourage away and the soldiers, police and their sniffer dogs disappeared, did the delegates think the day had been useful?

'Yes I do because we could let him know about the things on our minds,' said Jenny Weaver. 'I am not in the Labour Party - my husband is - but one criticism I would have is look at the delegates. This is a multiracial city and I counted just one person who didn't have a white face - that doesn't really reflect the place.'