The government’s commitment to choice and competition is unravelling.

Under world class commissioning, creating effective markets is supposed to be vital to raising quality and promoting efficiency. Primary care trusts have been encouraged to consider “any willing provider”.

PCTs are not even free to turn to another provider when the existing one is delivering a demonstrably poorer service

But last week health secretary Andy Burnham used an otherwise unremarkable speech at the King’s Fund to say the NHS is the “preferred provider” of services.

He went further. PCTs are not even free to turn to another provider when the existing one is delivering a demonstrably poorer service. The DH is to issue guidance on the process that should be followed to give existing providers an opportunity to improve before others get a look-in.

Muddled thinking is evident. The crucial passage in Mr Burnham’s speech begins by saying NHS providers are preferred to those from outside the service, but the subsequent wording on allowing the existing provider to get their act together seems to apply even if the PCT would want to move from one NHS trust to another.

When asked for clarification on the implications of Mr Burnham’s speech, the DH said there had been no change to the world class commissioning regime.

But that claim falls apart when the secretary of state’s words are compared with the 2006 white paper Our Health, Our Care, Our Say, which says a pivotal theme of the commissioning framework is to encourage open tendering as a way of stimulating innovation, quality and choice for patients.

There are similar disparities between the speech and the remit of the co-operation and competition panel - just a few months old - which is charged with ensuring competition between services is fair and transparent.

A fault line has opened up in health policy. Using competition within the NHS and between the NHS and the independent sector was one of the iconic reforms of Tony Blair’s “third way” politics. Ministers need to explain whether giving poor services a second chance is now more important than using competition to drive innovation, quality and choice.

Andy Burnham speech delivers body blow to NHS competition and choice