Politics live blog - Monday 17 January

11.14am: David Cameron has just started delivering his public service reform speech. It will be interesting to see how explicitly he addresses the concerns raised by his critics. Today the frontpage story in the Times (paywall) is based on a letter to the paper from six health unions, including the British Medical Association and the Royal College of Nursing, expressing "extreme concerns" over the NHS reforms. The unions are particularly concerned about the speed of the reforms and the introduction of price competition into the system. Here's an extract from the letter (paywall).

There is clear evidence that price competition in healthcare is damaging. Research by economists at Imperial College shows that, following the introduction of competition in the NHS in the 1990s, under a system that allowed hospitals to negotiate prices, there was a fall in clinical quality. With scarce resources there is a serious danger that the focus will be on cost, not quality.

Enforced competition will also make it harder for NHS staff to work collaboratively in multidisciplinary teams, across organisational boundaries, to create the integrated care pathways that patients want and need, and that will help to make services more efficient.

Furthermore the sheer scale of the ambitious and costly reform programme, and the pace of change, while at the same time being expected to make £20 billion of savings, is extremely risky and potentially disastrous.

10.49am: David Cameron is delivering his public service reform speech at 11am. I'll post a proper summary once I've had the chance to read the whole thing. But, in the meantime, it's worth pointing the fact that the extracts sent out to journalists last night contain an apparent inconsistency.

Cameron insists that he has been planning his reforms for a long time.

These changes have to be carefully worked through. And that's exactly what we have done through our years of preparation in opposition – and we will continue to do so every day in government.

But he also says that one of the good things about the coalition is that it has forced ministers to look at policies in a new way.

Politics should be no different from the rest of life, where rational people find a way of overcoming their disagreements ... Indeed, I've found that instead of arguing about tribal dividing lines or sticking to long cherished shibboleths, what we do is have a proper discussion about what really works ... And as you can see with radical policies from the universal credit in welfare, to free schools in education or strengthening our universities, the policies that result can be more wide-ranging and more effective than when you're working on your own.

10.41am: Here are a couple of assessments of David Cameron's performance on the Today programme earlier.

From Tim Montgomerie at ConservativeHome

It was a confident and persuasive performance from Mr Cameron although he was on shaky ground trying to explain away the pre-election promise not to reorganise the health service. Few would accept that the Lansley reforms are anything other than a radical change to the way that the NHS is structured. Necessary, perhaps, but certainly a big reorganisation.

From Paul Waugh at PoliticsHome

In his haste to get out the "don't settle for second best" message, the PM blurted out that people shouldn't have to settle for "second rate" healthcare.

Yes, that's right: "second rate".

He immediately corrected himself, acutely aware of the toxic nature of any outspoken criticism of doctors, nurses and others in the NHS. I suspect that correction won't stop Labour from hammering him hard, accusing him of insulting millions of hard-working public servants.

9.48am: Here are some of the quotes from the Cameron interview. I've taken them from PoliticsHome.

Cameron on why Britain should not put up with a "second best" NHS

These reforms are right. We obviously have to introduce them in the steady way that we're doing. You have to test your policies. But as I keep saying we should aim for excellence, we shouldn't put up with second best, we should recognise that doing nothing is an option which I think actually, could end in tears.

On why doing nothing on the NHS would be a mistake

First of all we're getting close now to spending the European average on health, so it's not a spending problem. But we are a long way from having the best outcomes in Europe. Our outcomes in terms of how long you survive from cancer, what are your chances of surviving if you have a heart attack, are worse than many countries in Europe. The second reason is that costs in the NHS inexorably go up as new drugs come on stream, new treatments arrive, as the population gets older and I don't think there is an option of just quietly standing still staying where we are and putting a bit more money into the NHS.

On why he promised no "top-down reorganisation" of the NHS

What I was objecting to that happened a lot over the last decade was the reorganisations where you took parts of the NHS like Primary Care Trusts and you renamed them Primary Health Authorities. What we are going to be delivering is an NHS that really depends on the decisions that we all make as patients and that our GPs make about where we're treated and how we're treated.