The price of NHS change

However, this does not give the Prime Minister carte blanche to press ahead with such far-reaching reforms of the National Health Service without thinking through the consequences. The timing may be convenient for Mr Cameron – he can, still, blame the failings of the NHS on his Labour predecessors – but it must also be remembered that he was advocating no top-down reorganisation of healthcare prior to the election.

What has changed? The formation of a coalition with the Liberal Democrats certainly provides the Tories with some political cover. Furthermore, the need for efficiency savings, to take account of an ageing society, means that health services need to become more efficient. As Mr Cameron said: "It's not that we can't afford to modernise; it's that we can't afford not to modernise."

While many will accept this, they will not tolerate Mr Cameron's arrogance, in a radio interview yesterday, when he dismissed – at times contemptuously –- concerns about his plan to abolish primary care trusts and enable GP surgeries to become responsible for large parts of the NHS budget.

His response to suggestions that this will create a federal health service, with different areas having conflicting priorities, was to point out that a 'postcode lottery' already exists. He seemed oblivious to fears this health divide could be exacerbated by his changes, changes, costing billions, that actually impinge upon people's lives.

Mr Cameron also assumed, wrongly, that GPs are always the best arbiters of provision when, in some cases, they run an appointments system that can pay "lip service" to the needs of patients. And, when the PM went on to talk about competition, and how this will drive standards, he did not seem to appreciate that many people have no choice over medical provision – they simply have to accept their local GP service.

Perhaps the PM's reforms may be less contentious if they were being driven by patients, the people that really matter, rather than political parallels with the past.

Less bureaucracy is certainly welcome. What will not be, however, are any changes that undermine the notion of a nationwide health service and see care become even more of a lottery.