Every healthcare system throughout the world is currently in the middle of a perfect storm.
The deepening crisis engulfing all health services has been caused by three crucial factors: ageing populations, mounting costs in advancing technology and treatment, and well-informed service users who are used to making sophisticated consumer choices.
Yet the problems are perhaps more acute in Britain than anywhere else in Western Europe, not least because our monolithic National Health Service is proving too inflexible, bureaucratic and outdated to meet the challenges of the new era.
Sixty years old this month, the NHS was designed for an entirely different age, when life expectancy was far lower, medicine was less complex and the British population, having emerged from six years of gruesome war, was much more subservient to state authority.
The Labour Government, while adopting an increasingly proprietorial air towards the NHS in the run-up to the 60th anniversary, has recognised the system is in dire need of reform.
The strategy adopted during the years of Tony Blair's rule was to throw vast mountains of cash at the system. Since Labour came to power, NHS spending has more than trebled, topping ?100billion annually.
But real change was not delivered, so the usual problems have persisted, particularly in the rationing of treatment, the differing standards throughout the country and the increasing costs of a top-heavy bureaucracy.
When Gordon Brown arrived in Downing Street last summer, he appointed a leading and very capable surgeon, Lord Darzi, as one of his health ministers and ordered him to conduct a fullscale review of the NHS.
The result is the document launched yesterday under the optimistic and slightly Soviet-sounding title High Quality Care For All.
But it would be wrong to be too cynical. Lord Darzi is a dedicated healthcare professional, not a calculating career politician, and there is much to admire in his document.
For a start, the idea of creating polyclinics in every town is an excellent one, vastly improving access to healthcare, especially for those who have busy working lives and cannot easily get to GPs surgeries during the day.
These new-style polyclinics have been given a bad press by the doctors' professional union, the British Medical Association. As a result of this negative campaign, they have been presented as a destructive alternative to the trusted GP.
Nothing could be further from the truth. Polyclinics are a complement to current services and, if run properly, they will expand the range of the treatments available, thereby reducing the pressure on hospitals and delivering care far closer to patient's homes.
Mind you, for all the benefits of polyclinics, it was this Government that shattered the tradition of GPs providing 24-hour cover through its disastrously botched negotiations of the last GP contract, which allowed doctors to reduce drastically their hours and yet receive more money.
In part, therefore, polyclinics are a solution to a problem created by ministers.
There are other aspects of the Darzi report to be welcomed. The proposed NHS constitution, which legally enshrines patients' rights, should act as a restraint on authorities trying to block certain types of treatment.
Lord Darzi's call for closer working between the various branches of the NHS is common sense, though too often ignored by empire-building bureaucrats who jealously guard their own territories.
Speeding up the procedures by which the National Institute of Clinical Excellence (NICE) decides whether to license a certain drug will also benefit thousands of patients.
But there is also a serious downside. As with so many statist plans, the expansion of bureaucracy becomes a substitute for real action.
Sadly, in failing to learn the recent lessons of history, Lord Darzi has allowed his plan to become littered with yet more extensions of the corporate state.
So we read that he wants a National Quality Board, a new Care Quality Commission, a new NHS Medical Education Service and a new Fit To Work service, as well as vast amount of new paperwork contained in the demands for 'quality accounts' - audits of how well patients are treated - as well as a host of other indicators, targets and box-ticking exercises.
Just as worryingly, there seems to be a fundamental contradiction at the heart of his document. On the one hand, he says he wants to end the ' postcode lottery'.
On the other, he argues that, to improve efficiency, better performing trusts and health centres should be rewarded with extra funding, while poor performers should be penalised.
But in practice, such an approach will only worsen the variation in the provision of treatment. In effect, patients will be hit twice over for living under an inadequate trust. The key is the lack of tangible incentives to drive efficiency.
So we need to admit - and this is almost heresy - that the NHS just can't do everything. We like to be sentimental about it as though it was a religion. It's simply a core service on which to build our own responsibility for health. Service users must make the transition into welcomed customers.
This brings us to the greatest weakness of Lord Darzi's scheme. For all Gordon Brown's talk yesterday of 'the bold vision' of the ten-year plan, in practice it is only perpetuating the failed structure of the NHS.
The fact is that the continuation of the state healthcare monopoly can never meet the needs of the British people in the 21st century.
This is partly because we have reached the limits of taxation on job-holders. Those in work would simply not put up with a further 5 or 10 per cent increase in their income tax to pay for the NHS.
But more importantly, the very existence of a massive bureaucratic monopoly breeds its own chronic inefficiencies, leading to widespread waste, mismanagement, low productivity and lack of pressure on suppliers and contractors.
In my own field of cancer treatment, for instance, many leading drugs are far more expensive in Britain than in continental Europe, for the sole reason that the absence of any commercial competition here means that the big companies can keep pushing up their prices, knowing that the Government will have to pay.
What we really need in healthcare is more competition, with the Government acting as the guarantor of a basic level of treatment for all patients. The NHS should be regarded as a private health insurance company, not a national religion.
Far from leading to injustices, the introduction of a proper market would actually lead to real reform, driving up standards and lowering costs, just as happens in most other Western countries.
A truly radical reform would be to give every individual a health insurance voucher, enabling them to choose to buy their treatment wherever they wanted. That would transform healthcare in this country far more than all the fine words of the NHS constitution.
• PROFESSOR Karol Sikora is a leading cancer specialist and former chief of the World Health Organisation Cancer Programme.
