Nicola Sturgeon is, in the present climate, that most unusual of creatures — the female politician who has grown more endearing the better we get to know her. In five years the deputy leader of the SNP government has gone from being perceived as the kind of woman the Scots call a nippy sweetie — spikey and lacking in humour — to someone who impresses even her enemies with her competence and an impish sense of humour. Charm, she has discovered, is the most effective political weapon of all.

Once in possession of it, life becomes altogether easier. As Cabinet Secretary in charge of health, the biggest prize of devolution, recent events have been kind to her. Swine flu recently thrust her into the UK spotlight, and she rose to the occasion with acknowledged confidence.

It is in the heated arena of health that Ms Sturgeon has overseen what amounts to a quiet revolution, diverting the NHS in Scotland away from the road of co-operation with the private sector, as has happened so markedly in England. The two services are now diverged to the point where they should hardly bear the same name: in Scotland there is no internal market, no new Private Finance Initiatives, no prescription charges, no parking charges at hospitals, free care for the elderly, and the imput of private companies into NHS services has been stopped.

Indeed, Scotland’s one and only private centre to cut waiting times, the Scottish Regional Treatment Centre at Strathcathro, near Brechin, is now under attack for inefficiency and Ms Sturgeon has ordered a formal review. Likewise, the health committee at Holyrood is at present closing the door to commercially funded GP services, despite suggestions they might solve the problem of out-of-hours cover in rural areas of Scotland But where does this apparent antipathy to privatisation come from? In an exclusive interview with The Times, Ms Sturgeon said that it sprang from pragmatism as much as from ideology. “I’m not going to sit here and tell you that as a politician of a particular party with a particular position on the political spectrum that I am ideology-free. You wouldn’t believe me if I was to say that and I’m not going to insult your intelligence. I’m a moderately left of centre, social democratic politician. I believe in a publicly funded, publicly delivered health service.

“I also, on a practical, ’what works’ basis, have never been that convinced that the market approach cuts it. You know a market in anything, in order to be properly functioning, has to deliver people meaningful choices. Now, we only have so many people [who] are qualified to do brain surgery or replace hips or deliver healthcare so I’ve never been convinced on a practical level that that kind of market approach philosophy in healthcare is particularly effective.”

She acknowledged that she was not an expert in the English system, but maintained that there was no evidence to suggest the private sector can improve the health service.

“I just have never really been convinced and nobody’s ever demonstrated it — certainly within a Scottish context — that the private sector can provide the solutions. . . . I’m not an expert on how the health service works in England. Obviously I know how it works but I’m not there on the ground, it’s not for me to pass judgment on it but I’m not convinced they’ve demonstrated it either.”

Ms Sturgeon went on: “I think for so long the answer to any question about health service efficiency or the need for improvement or reform in the health service has seemed to be private sector involvement. I think that’s lazy. I think it’s shorthand and I think it actually lets people in the health service off the hook, because the kind of things you really need to do to be more efficient in the health service are: making sure you’re using resources more efficiently, making sure resources are not being wasted on avoidable illnesses, making sure that you’re not treating people in hospital when you could treat them more effectively and more cheaply elsewhere. These are the harder things to do.”

She pointed out that “private sector involvement doesn’t increase the size of the cake. They don’t do it for free.” She contested figures from the Centre for Public Policy in the Regions, revealed by The Times, which found that there had been bigger gains in life expectancy in England than in Scotland since devolution, despite the proportionally higher health spend.

Cancer deaths in England, where there was a lower rate of the disease, had reduced almost at the same rate as Scotland, and their waiting times were much shorter.

Ms Sturgeon said the two countries prioritised different things. “We start from different places. Take health outcomes and health inequalities: it’s no secret that Scotland starts from a considerable distance behind the rest of the UK in terms of healthy life expectancy, for example, so to some extent in some of these things we’re playing catch-up.

“Scotland’s doing as well as, in some areas better than, England so, in short, these comparison are legitimate. We’ve got to make sure they’re true and meaningful comparisons but at the end of the day what matters across all these measurements is that we’re seeing progress in Scotland.” She acknowledged that in future “the budgets are tight and likely to get tighter”.

Times Recommends

• Should Knox’s trial even have reached the courtroom?
• All that glitters is not sold in Wright’s world
• Believe it or not, Big Brother is your friend