REFORM is vital to the National Health Service's survival. The architects of a system created half a century ago did not envisage the changing needs of the 21st century.

The involvement of private investment and giving more freedom to local hospitals to run their own affairs are an inevitable consequence of that reform.

However, while the structure and mechanics of the NHS have changed and will continue to evolve, the guiding principle of a service available to everyone and free at the point of delivery is paramount.

There are serious concerns about the prospect of Foundation Hospitals.

There is a risk that rewarding the better hospitals will starve other hospitals of much-needed resources.

Creating a two-tier service does not comply with the founding principle of the NHS.

People expect standards of care at their local hospital to be as good as any other hospital in the country. They do not have to expect to travel some distance from home to find treatment which matches their aspirations.

With Foundation Hospitals attracting all the attention and a lot of the investment, other hospitals will find it difficult to retain and recruit staff. For every Foundation Hospital of beacon status, there will be a 'sink' hospital of poor standards.

And there is every likelihood that the Foundation Hospitals will be in prosperous areas and regions, leaving those communities already suffering economic and social deprivation with the added deprivation of below-par health service provision.

The Prime Minister and the Health Secretary are adamant that the notion of Foundatioin Hospitals is the way ahead for the NHS. We remain to be convinced.

The probable rebellion among Labour backbenchers in the House of Commons tonight will be a timely reminder to them that reform is not automatically for the better.

Foundation Hospitals can only be a success if they raise standards across the whole of the NHS.

The onus on Mr Blair and Mr Milburn is to convince us that this will be the case.