“The big questions for the public who are the NHS patients of the present and the future are not how will the heath service be run but what will the health service do and how much money will it have to do it?

“The National Institute for Clinical Excellence is welcome as far it goes but the Government must come clean. Will it not still be the case that, under the Government plans for this parliament, rationing will continue by waiting lists and by postcode.

“Where is the proof that replacing one system of purchasing by doctors and health authorities by another system of purchasing by doctors will either be more cost effective or more co-ordinated let alone more accountable. Wouldn’t a merger of health authorities and social service departments under democratic control be a far more acceptable way of developing the health service than transferring more power to health professionals away from accountable representatives of the British public.

“Fewer contracts and contracts for longer periods are clearly a more efficient and more secure way of running the health service than thousands of contracts being negotiated every year. Is it really the case that the Government believes it can save one tenth of all the management costs of the NHS?

“The Labour’s election commitment was to ‘end the Conservatives’ internal market in healthcare’. Given that there will still be purchasers and providers, there will still be contracts (even if they are called service agreements) there will still be an internal market, although now it will be now Labour’s internal market. Is the Government really suggesting that purchasers will have no choice at all as to which Hospital or Trust they buy their patients’ health care from?