Page last updated at 13:00 GMT, Wednesday, 4 January 2006

Cameron's big health gamble

By Nick Assinder
Political Correspondent, BBC News Website

David Cameron
David Cameron says he would go further in reforming the NHS

Never mind the "Blair Lite" tag, if David Cameron continues as he has started he will attract the label "Blair full strength".

In a highly symbolic move, he has used the NHS as the first big policy announcement of his leadership - and has probably spooked both New Labour and some of his own backbenchers.

He has moved to ditch the Tories' Thatcherite, nasty party reputation and to camp his legions firmly on the centre ground once seen as Tony Blair's private playground.

He has even suggested he is ready to go further with his reforms of the health service than the prime minister has so far managed or been allowed to do - but in the same direction.

Specifically he wants more private involvement in the service, just as Tony Blair did but failed to deliver thanks, largely, to Gordon Brown and many of his own backbenchers.

Centre ground

In doing that, Mr Cameron has shown he has also listened to Tony Blair's declaration that he wished he had been more radical in his early days in power.

Mr Cameron clearly intends to start with the radicalism. And throwing out the historic Tory commitment to allowing individuals to buy out of the service - a central policy in the 2005 manifesto he helped write - is about as fundamental as it gets.

And he made no bones about it - encouraging private health insurance to allow the better off to opt out of the NHS will "never" be part of his policy.

It puts Tory and Labour policies in the same pen on that same centre ground on which Mr Cameron and many others believe general elections are fought and won.

As New Labour once boasted about "crowding out" the Tories by closing off areas of policy difference, so Mr Cameron is attempting to shut out the government.

At worst it will deny Labour the old, and generally successful, election slogan that the Tories can never be trusted with the NHS. At best it will paint David Cameron and the new Tories as the real radicals, doing the things New Labour once promised yet failed to deliver.

Thinking the unthinkable

This is all, of course, assuming his party will let him get away with it.

There will be many traditional Tories both on his backbenches and in the wider party who will be deeply concerned about this fundamental, ideological change of direction.

They may even claim they were mis-sold David Cameron, believing that - despite his insistence on modernising the party - he was committed to the policies on the NHS that were included in that manifesto he wrote last April.

He may not mind that too much. If he is to carry out his modernising agenda, that battle will come one day or another.

So it is probably as well to get it over with now when he is at his strongest.

Meanwhile, he has promised more to come but, for now at least, he has shown the ability to, in Tory terms at least, "think the unthinkable".

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