A Conservative administration would increase health spending by up to an extra £28 billion a year, a leading moderniser has told The Times. Andrew Lansley, the Shadow Health Secretary, gave a long-term commitment that under the Tories health spending will rise to take up an extra 2 per cent of GDP.

“I think we are bound to have rising real-terms health expenditure,” he said. “That means that health expenditure is going to be a rising proportion of total public expenditure.”

It is the most explicit pledge to increase spending on the NHS since David Cameron became Tory leader and take the party into territory beyond current Labour commitments. But Mr Lansley said that funding such increases would require cuts elsewhere in public services if the Conservatives were to meet their tax pledges.

In his exclusive interview with The Times he also admitted that the Tories had not yet broadened their appeal enough to be elected.

George Osborne, the Shadow Chancellor, has based his economic strategy on the Tories reducing, over time, government spending as a proportion of national wealth. Mr Lansley’s pledge means that a Tory government would have to find billions of pounds of cuts from other areas such as education, the police, transport and defence.

The Shadow Health Secretary,who was recently guaranteed his post by Mr Cameron until the next election and beyond, is blunt about the consequences. He said that it would mean spending elsewhere slowed or even slashed. “It’s tough. It means there are places where public expenditure will decline as a proportion of GDP or in some cases in absolute terms.” He says it is “not for me to say” where the axe will fall. “I just think we are being realistic here.”

His projection will dismay the Tory grassroots, who have been pressing for Mr Osborne to abandon a pledge to match Labour’s spending totals until 2011. It also risks irritating Shadow Cabinet colleagues such as Liam Fox, the Shadow Defence Secretary, who has criticised government cuts to military budgets. But it will disappoint Labour, which hoped to make health a key dividing line at the next election.

Mr Lansley said that he was not binding the Tories to specific proposals but the burden of health spending in an ageing population explained the priority he has given public health in Conservative policy proposals.

His comments align the Tories for the first time to the projections of the Government’s own health adviser, which Labour ministers have yet formally to match.

“Over 25 years if we don’t achieve better public health outcomes we become potentially unsustainable, or they will be unsustainable in a purely taxpayer-funded system,” he said. “America, arguably, is itself moving towards a situation where its healthcare expenditures are unsustainable but they are not all funded out of taxation. We don’t want to get to that position. We are at, what, 9 per cent of GDP. We don’t want to get to 14 per cent of GDP. We’re going to get probably to 11 simply through the progress of rising health expenditure and life.”

Although the NHS is internationally admired it must embrace choice and competition, says Mr Lansley, who describes himself as “someone who is involved with the health service who happens to be a politician”.

He is scathing about the Government’s attempts to legislate healthier behaviour, citing the “traffic light” labelling scheme as an example of ineffective regulation. The Tories will resist any attempts to extend a ban on junk food from children’s TV to other programmes popular with youngsters.

He defends the Tories’ moratorium on hospital closures and mergers, dismissing suggestions that it would cost lives. Government claims that maternity services are best in large hospitals are undermined by Healthcare Commission ratings which suggest that smaller units do better, he says.

He blames Alan Johnson, the Health Secretary, for alienating GPs. Asked about the British Medical Association’s leadership, he said: “They disappoint me. They tend to take a negative view of everything that’s proposed. They should be providing solutions.”

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