If the headlines told the story of patients being offered a wider choice of GP, then the real message of the English health secretary’s recent speech at the King’s Fund was that the election debate on the future of the NHS starts now.

In a wide ranging analysis of the state of the NHS and options for its development, Andy Burnham set out the government’s stall and threw down the gauntlet to his opponents.1

At the heart of his speech was the argument that the performance of the NHS has improved in the past decade and needs to progress further in the next. This means holding on to gains such as shorter waiting times for treatment, and giving more attention to improving the quality of care and prevention.

Echoing his predecessors, the health secretary reiterated that future improvements need to be brought about from the bottom up rather than imposed from the top down. To this end, he emphasised that the programme of work on measuring and rewarding the quality of care set out in Lord Darzi’s NHS Next Stage Review2 will be given priority, with hospitals being paid more for better patient experiences.

In a subtle but important shift in policy, the speech also signalled that the use of independent sector providers will only be considered if the NHS …