"When patients are turned into consumers who shop around for the best deal, there will be winners - the well educated, the articulate and the mobile.
It is the vulnerable and the marginalised who will be the losers. The pure market approach to public health does not work.

"But there is a way another way to introduce competition in the NHS - political competition.

"There is a strong argument that accountability and activity in the NHS should be radically decentralised so that local people know what’s going on in their local health service, and elect local politicians according to their proposals for improving it.

"Under such a model accountability would be the driver of improvement. Because if one party running that local health service fails, others with better ideas will be elected to replace them. Local NHSs could still work together where it made sense – delivering specialist services, or to cut procurement costs – but they would be accountable directly to local people, not upwards to the secretary of state."