NHS shake-up must be lasting

This is, effectively, a rite of passage for every postholder, even though this sustained tinkering has left health services in a permanent state of upheaval and bureaucratic muddle.

Many will, nevertheless, welcome Mr Lansley's results-driven framework that places a premium on the quality of care provided to patients rather than targets like waiting times.

It's self-defeating if people have to be readmitted because their treatment has been rushed to meet government guidelines or targets, and Mr Lansley recognises this.

Yet, before inflicting yet another series of Whitehall-driven changes on hospitals and GPs, it would have been to the Government's advantage if it had set out, clearly, its future vision of the NHS – and how this can be achieved with an ageing population and increased public expectations.

Ministers also need to spell out whether health spending is ringfenced or not, after Mr Lansley gave the impression that his changes will be funded through efficiency savings.

This lack of clarity runs throughout the policy document that Mr Lansley finally unveiled yesterday after days of leaks – a tactic that should have been consigned to history when Labour left office.

The Health Secretary wants to give GPs greater powers to control their budgets, but this threatens to turn doctors into accountants and see them spend even less time with patients – a clear contradiction that the Minister needs to remedy.

And, while the devolvement of services is clearly one of the coalition Government's key principles, it must be remembered that doctors are powerless when it comes to the decisions of Nice about the suitability of new drugs – and the cost implications for a NHS that is going to have to start living within its means.

That is why the Health Secretary needs to proceed with caution and only start subjecting the NHS to even further upheaval when he is certain that the changes will lead to improved services and efficiency savings. Change for change's sake is not a lasting remedy.