“Every time I’ve introduced a reform, I wish I’d gone further.”

Tony Blair felt that political opposition to any reform was inevitable. But not even he could have predicted the opposition that faced the Health and Social Care Bill (2011), and the subsequent £2-3 bn top down reorganisation.

The striking thing was that Ed Miliband’s “Hugo Young” speech yesterday did not, in fact, leave you with the impression that his Government “believes in public services”.

Blair felt that his first term in government did not adequately deal with public services. Blair set out his agenda on winning a second term.

“It is a mandate for reform, and an instruction to deliver.”

With the landslide victory of Tony Blair in 2001, Blair believed that Labour “was at his best, when he was at his boldest”. On the other hand, Gordon Brown believed that Labour “was at its best when it is united, best when it is Labour.”

In January 2000, Blair responded to a flu crisis by producing a massive splurge on the NHS. Labour now is obsessed about sticking to the austerity programme, to prove its fiscal credibility. So spending to kickstart yet further reforms of the NHS may not be an immediate option.

The extent to which a Miliband government would be able to deliver a costly set of reforms depends on what his relationship with his Chancellor of the Exchequer is like at the time. At the moment, it can’t be certain that this person will be Ed Balls, who generally positioned himself in the impossible position that the recession would never end.

If Miliband is genuinely concerned about ‘accountability’ for the financially autonomous independent NHS Foundation Trusts, he will have to address how local accountability is in fact lost, in terms of ability to pay for staff and services, if budget sheets are biased by unconscionable interest repayments for PFI.

If Miliband is genuinely concerned about ‘accountability’ for clinical performance, the NHS complaints system and higher regulation must be made fit for purpose. There are concerns about both aspects, and much can be done procedurally to make improvements here.

Ed Miliband wants to be the man to ‘clean up politics’.

It might be procedurally easy to promise and deliver low taxes, if the economy is growing. However, it is an altogether different matter to take to the public that lower taxes might lead to more unaccountable outsourced functions, say in probation or health, where taxes end up subsidising shareholder dividends.

So one of the reforms left to Ed Miliband is public ownership.

It has been argued that bringing NHS services back such that delivered by the State would be prohibitively costly, but not if a Government wishes to maintain excellence in NHS-supplied services and therefore aspires for the NHS to win contracts on an equal playing field basis. At the moment, pitches are won on the slickness of the presentation rather than corporate  ongoing performance management.

Miliband may wish the NHS is not political. But it is.

For example, if he wishes primary care to be run by outsourcing companies on behalf of the NHS, there is nothing to stop him legislating for this.

However, on the basis of ‘reforming public services’, it may be a step too far for the ordinary Labour voter.

The argument, that if the time it takes to see your GP is improved, it doesn’t matter who provides your GP services would be the predictable counterargument. It’s this sort of argument which will differentiate Miliband from New Labour – or not.

The paradox is, even if you discount that the greatest legacy of Baroness Thatcher is said to have been New Labour by the lady herself, the centre of gravity has swung away from fragmented, privatised services to a more left-of-centre dialogue.

A gift which has been handed to Miliband on a plate is the failure of the privatised utilities. From that, it has been low hanging fruit to redefine the Markets.

In response to Jeremy Paxman’s question whether Ed Miliband wants a “slimmed down state”, Liz Kendall MP, Shadow Minister for Care Services, offered that Miliband wants a “reformed state”.

Of course, offering unified personal budgets in the form of ‘whole person care’ would be a perfect vehicle for a reformed state. But Labour knows – and ultimately we will know – that it might also be a cover for a ‘slimmed down state’.

Ultimately it’s never been proven that the public actively endorsed the selling off of State assets, like Royal Mail, where there had been some public investment; nor did they ever sign off foreign ownership of previously State infrastructure.

But whilst Labour is in the hock of the City and the hedge funds, rather than the Unions, the reformed State might simply be the Square Mile after all.

What mandate does Miliband seek for his version of the State, and will he deliver?