Lord Darzi of Denham, the Minister of Health, is the most politically important of the outside “talents” recruited to government by Gordon Brown when he became Prime Minister. As an eminent surgeon with a serious interest in the strategic questions that surround health provision he carries considerable personal credibility. Any review of the NHS cannot, however, be an abstract exercise. Deciding what should be considered priorities will drive the recommendations that emerge out of the enterprise. The bulk of the interim report published yesterday concerned access to GP clinics and the extent of MRSA in hospitals. These do concern patients, understandably, and hence politicians. Yet if every GP clinic were open all hours and every hospital ward spotless (unlikely outcomes, admittedly), the quality of health provision would not of itself be transformed.

Lord Darzi’s suggestions on these issues are broadly sensible. There is a case for a periodic “deep clean” of hospitals, as the Prime Minister suggested last week, and the testing of patients when they arrive in wards is also rational. These measures would still have to be supplemented by more basic, even monotonous, behaviour such as nurses rigorously washing their hands between contact with every patient. Similarly, while ministers are entitled to want to ensure that GPs and their clinics are more widely available to the public, there is not necessarily a relationship between the hours for which a clinic is open and the quality of treatment. This sort of initiative might be popular but unless it is allied with a raft of other measures it will be incremental and even ornamental.

In other areas, Lord Darzi is less convincing. He points out, as others have observed before, that the NHS is frequently tardy in adopting new ideas or embracing new technologies.This is in part because its very size makes it a flat-footed animal. The solution offered, namely the creation of a Health Innovation Council, based at the centre and doubtless composed of leading members of the medical establishment, is no more likely to inspire innovation across the whole of the NHS empire than similarly grand organisations such as the existing NHS Institute for Innovation and Improvement have done.

The fundamental dilemma of the NHS is that the incentives to engage in change are minimal.

Those who take risks sense that their only reward will be controversy. The compelling requirement for reform is cultural as much as clinical. While managers believe that their primary roles are to avoid financial deficits and too many adverse stories surfacing in the local press, then the idea that they will engage in experimentation is fanciful. And while this remains true, the NHS will produce results which, while often brilliant, can also be disappointing by international standards across a range of diseases and conditions.

The Darzi review is in danger of being little more than sticking plaster. It may well deal with some of the most publicly manifest deficiencies of the system but do little with more fundamental failings. What is required is a more sweeping debate about whether the basic model of health-care in Britain is still suitable for modern circumstances, and whether health workers are flexible enough to cope with the contemporary challenge. The depressing fact is, though, that whether the general election be this year, next year, 2009 or 2010, none of the political parties has yet shown a willingness to confront the institutional flaws that ail our health system.