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Commentators discuss NHS reforms outlined by David Cameron on Monday.

that hidden away is a brief clause that appeared without public announcement which will "blow apart the unified NHS as a service and turn it into a purchasing agency":

"Paragraph 5.43 says: 'One new flexibility being introduced in 2011-12 is the opportunity for providers to offer services to commissioners at less than the published mandatory tariff price where both commissioner and provider agree.' It adds optimistically: 'Commissioners will want to be sure that there is no detrimental impact on quality, choice or competition as a result of any such agreement.' This is dynamite. When Cameron confidant Nick Boles MP spoke revealing and unwisely of creative 'chaos' in public services, this is it. The introduction of unfettered price competition leaves all the NHS open to challenge and undercutting from any private company offering temporary loss-leaders. The destabilising effect on financially fragile hospitals will be devastating."

that competition will be good for the NHS:

"Foundation trust hospitals, the supposed vanguard for public membership of NHS organisations, have in many places become self-serving monopolies.
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"This is why competition is needed in the NHS; not on the basis of neoliberal dogma, but because competition, more than any other system, permits the pluralism for new ideas to flourish; new ideas the NHS so badly needs if it is to find a way out of the overarching difficulty it currently faces: getting greater value for every pound of taxpayer funding."

The the reforms are necessary:

"The statistics suggest Mr Cameron is right to say that doing nothing is not an option. During a decade in which health spending has doubled in real terms, NHS productivity has actually fallen by three per cent. Meanwhile, clinical outcomes have deteriorated, with cancer and heart-attack victims more likely to die here than in most other countries in Europe. At the same time, as Stephen Dorrell points out on this page, the squeeze on public spending means that the NHS is being required to achieve the most demanding efficiency savings."

that these reforms show David Cameron's true colours:

"Mr Cameron did not put his proposals to the electorate last May. Instead he promised there would be no more big reorganisations of the NHS, insisting that there had been enough of those. He must have known he was planning the biggest reorganisation in the institution's history, so the lack of candour highlights the degree to which Mr Cameron is committed to his NHS crusade. He was willing to risk being exposed as duplicitous in order to win power and then press ahead."

that reform may be diluted by the time it is implemented:

"Mr Lansley has agreed to phase in his changes partly to keep them happy. The Prime Minister and the Chancellor have been convinced, intellectually, of the case for reform of the NHS, but they are all too aware of the risks. Mr Cameron will be 'watching this like a hawk', an aide said.
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"There could be more concessions to come. As one Cabinet minister puts it: 'We can accelerate or brake in light of experience.'"

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