It was sad listening to a surgeon turned government Minister (Lord Darzi) wriggling on the Today programme, unable to answer the easiest of questions. He may be a very good surgeon but he clearly struggles to understand how to reform the NHS and how to explain the reforms it needs.

He has famously told us previously that the days of the District General Hospital are numbered. Yet today he sought to expugn that comment, confining it to parts of London. Why didn’t he go into more detail about the dangers and drawbacks as he saw them of concentrating most health care into single monopoly hospitals serving quite large populations? Why has he now decided a world of greater choice and different types of health care provision is wrong? He cannot claim the future lies with a few excellent centres for cancer and cardiac work, and with plenty of smaller units for other kinds of treatment on the one hand, and then reassure us that the District General carrries on regardless on the other.

He was even more unconvincing about the timing of his announcement today, unable to deal with the obvious allegation that it is all part of a plan to say something warm and positive about the Health Service before an early election if the PM finally wants one.

He took a long time ruling out extra fees and charges in the NHS, when the BBC put to him that many surgeons working in the NHS think that is the way to change it.

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