In 1997, when it took office, the Labour Government promised that the National Health Service (NHS) was safe in its hands. The founding principles defined in 1946, of universality, comprehensiveness and predominantly free healthcare, seemed safe. When, in 2000, The NHS Plan added “patient choice” to the list (patients choose services and not services choose patients), it seemed a decent proposition despite being unclear how compatible it would be with the other three principles.

The introduction of performance targets and payment by results in recent years aimed to improve standards and to develop competition both within the NHS and with independent providers. Achievement of performance targets (regardless of the often nefarious means used to achieve them) certainly gave the government some sound bite headlines with which to sell to the public their belief that the huge financial investment in the NHS was having a positive impact. In the run up to the 2005 general election most people believed that all was reasonably well in the health world, and only those with an ingrained scepticism as well as perennial doubters had cause to think otherwise.

Since the …