Leading article: The right medicine, but far too mild a dose

There are some decent ideas in Lord Darzi's long-awaited report on reforming the National Health Service. The proposal to shift minor surgery operation out of hospitals and into "polyclinics" makes sense; so does the idea of encouraging collectives of NHS nurses to set up their own independent health centres. The fact that these reforms have drawn fire from that most reactionary of unions, the British Medical Association, is, in itself, a sign that the rest of us should welcome them.

There are also some fine sentiments expressed in Lord Darzi's report about the need to widen patients' choice and to build a more "personalised" NHS. Other proposals are sound too. The process for licensing new drugs should indeed be speeded up. And there ought to be a greater focus throughout the system on prevention as opposed to cure.

But these are merely encouraging details. What is missing is any grasp of the big picture. The truth is that Lord Darzi's report falls short of being the radical new policy blueprint the NHS needs as it approaches it 60th anniversary. Much of the report comes across as a charter for bureaucratic tinkering.

There seems to be little in the proposed "NHS constitution" that is not already reflected in the present ad-hoc arrangements. Worse, the report contains nothing that would break the stifling hold of Whitehall over the major delivery mechanisms of health care. There is much talk of decentralising provision of services, but without the right policies, it is impossible to see this actually taking place.

A staggering amount of public money has been invested in the NHS since 2000. But, as just about every independent audit of the service over the past eight years has concluded, these sums have not been spent efficiently. There have, of course, been some improvements. Operation waiting times and waiting lists are far shorter than they were a decade ago, for instance. Cancer and heart disease survival rates have shown a significant improvement. But the results should have been substantially better. Taxpayers, with justice, do not feel they have received value for money.

The Government is right in its view that putting more power in the hands of patients will drive improvements throughout the system. But the only way ministers will deliver this devolution of power is by increasing competition between providers within the NHS.

Linking a portion of a hospital's future funding to patients' reviews of its performance, as Lord Darzi proposes, is no substitute for increasing the role of the private sector. And rather than promising to give medical staff a greater role in setting the priorities of the NHS, the Government ought to be looking for new ways to take on the vested interests that proliferate in the provision of public health care.

What we need is not tinkering, but a transformation. The Government will always need to be a guarantor of a certain standard of medical care within the NHS. It will also, inevitably, have to play a role in rationing provision in an era when pharmaceutical prices seem to be heading inexorably skywards. But governments of all stripes need to accept that they cannot continue to take a hands-on role in the delivery of care. The Whitehall command-and-control model that has prevailed for six decades has outlived its usefulness.

The public has begun to recognise this. Our political leaders need to catch up. If the NHS is to celebrate further decades as a cherished national institution, such a transformation will be not a luxury, but an imperative.