Tinkering with the National Health Service is almost irresistibly attractive to politicians looking to leave their mark on history.

Its founder, the Labour minister of health Aneurin Bevan, saw the health service as the embodiment of a new egalitarian Britain emerging from the ashes of World War Two, and every government since has indulged in some kind of reform or reorganisation.

But to describe the current coalition government’s proposed plans for NHS change as mere tinkering is like saying HMRC has a passing interest in taxation.