No time to hesitate in the health service revolution

Tony Blair spoke with convincing frustration last week of journalists' failure to realise that "there is a revolution going on in the National Health Service at the moment". By implication, he was expressing his disappointment with the ingratitude of the electorate, who persist in withholding their judgement until they see results.

There are big changes under way in the NHS, and the spending increases planned for the next five years are huge. But two of the difficulties in the way of the revolution have been identified by Adair Turner, the former CBI director general who is one of the Prime Minister's "blue sky thinkers". In the short term, he is worried that the reforms will create a two-tier health service. When the best, "three-star", hospitals are allowed to manage themselves, they will be able to poach the best doctors and staff.

There is a danger, however, that this warning will be exploited by the opponents of change to hold it back. The trade unions will step up their complaints about the return of the Tory internal market and privatisation by stealth. The real lesson of Mr Turner's warning should be that the reforms should go faster and further. The best way to avoid the development of a two-tier service would be to grant self-managing autonomy to all hospitals.

There will be problems thrown up by the lack of capacity in the short term. Patient choice cannot become a reality until there is spare capacity which allows people to choose where to go. But the more patients or GPs on their behalf are able to exercise real choices, the faster the extra spending will generate more capacity.

Mr Turner's second observation follows from this. It is that every NHS procedure and operation must be priced. This is already happening, but must be speeded up. The sooner it does, the faster new providers of publicly-funded health care will come forward.

If there is a revolution going on in the NHS, it needs a sense of urgency to carry it through.