Why do we really want competition in the NHS?

No, it's not just so that we can financialise all that is holy, expose the UK's great socialist experiment to filthy lucre. The reason, actually, is so that we can try and work out how to make the NHS better.

There's a report in the BMJ about how independent sector treatment centres (ISTCs) have been doing and the general answer is, umm, OK really. The medical outcomes are a little better than the standard NHS, even allowing for the different mix of patients. And the patients seem to like them more than he NHS as well. Better production and happier customers: but only a bit. It's not a bad outcome certainly.

It's also not quite enough to provide a conclusive answer to the question of why we want to have competition in the NHS. A bit better is, after all, only a bit better. The true answer about competition is that no one actually knows how to make health care better. I most certainly don't, I doubt you do and I know absolutely that Andrew Lansley doesn't. We also know that the knowledge of how to, perhaps, make it better is local: it's in the hands of the surgeons and nurses and managers and cleaners and aides and porters and......So, what we want to do is open up the space, allow people to try things out, provide them with incentives to do so and then we can see what works.

For example, perhaps this would be a good idea?

This is cardiac surgery on the production line, in an extraordinary hospital in India.

The Narayana Hrudayalaya in Bangalore is the largest heart surgery hospital in the world. It has 1,000 beds, and last year it carried out a staggering 6,000 operations, half of them on children.

By contrast Great Ormond Street in London did less than 600.

"We are all products of the National Health Service in the UK, and what we learnt over there we have implemented in perhaps a slightly different manner," says Dr Devi Shetty, India's most famous heart surgeon, and the driving force behind the hospital.

"We believe that the only way is to build large hospitals - 100 or 200 beds are not going to be the solution for the current world health problem. We need to build large hospitals where hundreds of operations are carried out every day."

And here in Bangalore, the theory appears to work. Despite the huge volume of operations, mortality rates are comparable with or better than those in Britain and the US, and costs are much lower.

Maybe this is a good idea, maybe it isn't. I don't know, you don't and Andrew Lansley doesn't. And that is the reason that we want competition in the NHS. We're all entirely buggered as to how to make it better. So we must open it up to experimentation, to that market process of trying things and then sorting through the successes and failures, so that we can actually work out what does make it better.

Yes, there will be failures just as there will be successes. But the evidence of the 20th century is that such market processes reduce costs and improve outcomes over time. A useful lesson for us to remember in the 21 st century.