The shadow health secretary, Andy Burnham, is planning another huge shakeup of the NHS. His statements at this week's Labour conference are couched in terms of getting the structure he would inherit to "work differently". The reality is that he is proposing far-reaching change with significant risks for service quality.

At a Guardian healthcare network fringe meeting on Tuesday Burnham said: "The health service would not survive two terms of [David] Cameron … the NHS would not be a national service at the end." Such remarks are a conference ritual; I remember listening to the then shadow health secretary, Robin Cook, warn in 1991 that if Labour lost the election the following year, it may be too late to save the NHS. The Tories got back in, the NHS survived. It will this time as well.

Burnham's fears about losing the national character of the NHS are based around increasing use of the private sector, and the fact that competition between hospitals is seeing big trusts surge ahead, while others are struggling.

He described the imminent tendering of 396 community services as "the single biggest act of privatisation that the NHS has ever seen", with a total value "up to a quarter of a billion pounds". That actually amounts to less than 0.25% of NHS spending, so even if the whole lot went to the private sector it would not make much difference to the current non-NHS proportion (including charities) of around 5%.

He wants the NHS to, in effect, return to the "preferred provider" policy he tried to pursue during his 11 months as health secretary at the end of Gordon Brown's government. NHS services would routinely win contracts, with use of the private sector being the exception.

The risk of the preferred provider model is that it means contracts will go to NHS providers even when the service is inferior to that being offered by the private sector. So you are saying to patients: "We are knowingly going to provide you with an inferior service because our ideology is more important than the quality of your care."

Burnham told the conference he wanted to "remove entirely" the "competitive structure that all hospitals and health providers will have to work within" under the new legislation, and "restore the legal basis of the NHS to a national, planned, collaborative system … that's why I need to repeal the market madness that David Cameron has brought to the NHS".

If he intends to pursue this literally, it is not clever. Competition has an important role to play in improving quality, notably with elective surgery. Collaboration and integration are also vital. What matters is what works. (Watch King's Fund chief executive Chris Ham neatly summarise how they fit together in a high performing health service.)

The concept of autonomous foundation trusts was part of a two-pronged move to raise standards. Inspection and regulation were intended to deal with the worst performers, but it is impossible to regulate your way to excellence. Foundation trusts, freed to compete on quality and efficiency, would be encouraged to attract the finest clinicians, build the best teams and constantly push the boundaries of innovation and excellence. There are examples across the NHS of foundation trust departments providing care that is stunning, even by international standards.

Burnham is right, of course, that a good number of hospitals are struggling. But the answer is not to rein in autonomy and ambition; as this column argued two weeks ago, it means taking tough decisions about centralising some services in centres of excellence with higher quality and lower death rates.

Pursue ideology or pursue high-quality care – you can't do both. While unrestrained competition is foolish, centrally planned and controlled healthcare is a recipe for mediocrity. Go down this route and in very few years we will look at the fast-improving quality of care in countries such as Brazil and India and wonder how we failed to keep pace.

This article is published by Guardian Professional. Join the Guardian healthcare network to receive regular emails and exclusive offers.