Health check for NHS reform

That the Prime Minister answered a direct point so indirectly reflects the size of the gamble that he is taking with the Health Service, especially as he promised, before the election, to halt top-down management changes because they were counter-productive and undermined staff.

The NHS does need surgery. The third largest employer in the world, it must not be immune from the efficiency drive now underway across the public sector. Waiting lists, as highlighted by Labour leader Ed Miliband, are one aspect of this process. Yet the Conservative leader's impatience could prove costly if unprecedented financial powers are passed to GPs, with experts warning that this process could lead to more – not fewer – bureaucrats.

A respected Tory backbencher, who worked as a family doctor, has also accused Mr Cameron of "tossing a hand grenade into the NHS". It can only be hoped that Mr Cameron listens to the MP in question, Dr Sarah Wollaston, before his haste causes lasting damage. Every health shake-up in recent times has failed to achieve the expected financial efficiencies, and there is no guarantee that Mr Cameron's approach – pay now for savings in the long-term – will yield a sufficient dividend to justify such a major upheaval.

He is, of course, right when he says the NHS, with levels of funding now comparable to the rest of Europe, is not as productive as health services elsewhere. Yet passing sweeping powers to GPs, a move which could be reversed by a future government, should not be the starting point for efforts to reverse this imbalance.

In short, the Government needs to decide, in light of an ageing society, what kind of NHS should be in place in five, 10 and 20 years hence – and then decide the best way of meeting, and financing, these objectives, including the length of time people should expect to wait for hospital appointments and the other priorities of patients.

It will be a far more productive than rushed reforms that leave too much to chance, and the peculiarities of the NHS internal market.