Short-term gains with long-term costs

Patricia Hewitt's announcement today of greater private-sector involvement in the NHS will stir up afresh the arguments over whether such moves add up to the privatisation of the health service.

The plan is to farm out more of the NHS's routine operations to bring down waiting lists. That goal is politically urgent: the Government's new target is to reduce the maximum wait for any operation to 18 weeks. And the Prime Minister has signalled that he wants to think radically, rejecting former health secretary John Reid's suggestion that the work farmed out would be limited to 15 per cent.

Ms Hewitt says using private providers in this way does not compromise the principles of the NHS because all such treatment will still be free at the point of delivery. Her critics say it is the thin end of the wedge. They point to the high cost of such operations and to the unfairness of successful NHS hospitals being barred from bidding for the work even if they have the extra capacity.

Greater use of private treatment centres also means we will see more NHS hospitals with empty beds and closed wards - which is already happening at London hospitals, including the flagship Ravenscourt Park Hospital. Ultimately-whether the new system-works or not is a question of money. Few people will complain if they get their operations done more quickly - but they might be less happy if the overall cost to the NHS is much higher.

And while politicians and patients might like the idea of more choice and less waiting, that means creating spare capacity in the system. That will cost more - and it will mean more NHS wards and less popular hospitals, along with their A&E departments, closing.