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Can't disagree with this. One of the major failings of Lansley's vision was that he thoguht that real change and the Nicholson challenge could be driven by year on year salami slicing and the mutltiplicity of thousands upon thousands of individual market exchanges between patients and GPs, focused largely on choosing elective care. That was naive.

The reforms talked a good game about the rising elderly population and the challenes of long term conditions. But it ducked the fact that the future demanded a massive reshaping of healthcare; more support in the community setting, less hospital care, tough decisions. That's a serious strategic planning challenge, needing strong nerves, convincing arguments and clinical and patient buy in to create bold solutions. And it won't happen in neat annual packages of 4%. And the amendments presented yeaterday, to my mind, still don't creat the environment for that kind of necessary, robust, innovative and inclusive thinking.