Professor Nick Bosanquet
Health policy expert
The future of NHS care does not lie in bricks-and-mortar hospitals, according to policy expert Nick Bosanquet.
In this week's Scrubbing Up Professor Bosanquet, a director of the centre-right think-tank Reform - predicts we could one day be texting in test results day and night to doctors who could give an instant verdict.
The NHS has a powerful fixation on hospital treatment - even though it does not have the staff on many wards to deliver a reliable quality of care or basic information on outcomes.
Instead of tinkering with the existing system, perhaps it is time to start on more radical changes.
The NHS should establish virtual hospitals that can provide 24-hour cover.
Patients could be sitting at home and could send in data on their condition. They could get in touch with doctors very easily, perhaps by text.
And there are recorders now which can send back pulse rates, or even take a blood sample to monitor things like blood glucose levels.
Instead of thinking about how they are going to get to hospital, patients could get immediate answers and immediate help for their problems.
Hospitals would become communication and day treatment hubs.
Wrong hospital - wrong place
The concept of virtual medicine is gaining a following, particularly in rural areas such as Cornwall and in Kent.
And there are projects such as the one that actually works at Kingston Hospital where young people can go for sexual health checks - and get the results texted back to them.
That's something that would have been unheard of a few years ago.
Too often priorities in the NHS have been set not by customer needs but by a trinity of providers - big government, monopoly professions and big contractors.
The NHS is building the wrong hospitals in the wrong places - a kind of health Maginot Line.
The losers have been the patients who have lost out on better care.
But the new spending limits placed on the NHS could trigger a rethink.
Funding increases are predicted by the government to fall from 9-10% a year to 3-4%.
That's no reason for gloom. It could spur a redesign over the next decade to more personal, more effective services.
There has been little incentive to invest in a new kind of health service while the easy option of continued growth in high spending in the old one remains.
But even during the high-funding period, many of the most effective programmes have been low-cost - such as the National Service Framework for coronary heart disease which identifies and treats high-risk patients.
And the quality agenda set out by health minister and surgeon Lord Darzi recently showed how quality does not need big spending.
We should put the advances in communication technology which have revolutionised services such as air travel to better use, through locally driven investment programmes which create powerful incentives for fast results.
Above all we must give the local health agencies the power and the responsibility to develop new kinds of links with users and offer them a greater range of providers.
Local teams must be empowered to invest in new ways of providing care financed by savings on obsolete services.
This new agenda faces up to the fiscal and labour market consequences of an ageing population.
With fewer younger tax-payers or healthcare workers and more older service-users, we have to look at ways of producing more value for the health pound.