Prime minister defends plans to introduce more choice into public services and says the government has a once-in-a-lifetime opportunity to make reforms

David Cameron today urged critics of his plans to introduce greater choice in public services to grow up, and realise the public are concerned by the standard of a public service rather than whether it is delivered by a charity, private company or a public sector worker.

He said the government had a once-in-a-lifetime opportunity to modernise public services but Labour claimed he had broken an election promise not to impose top-down organisational change.

He called for a more elevated national debate, adding that his drive to introduce greater choice and act with speed in part stemmed from his reading of what he described as the intriguing autobiography of Tony Blair.

He said the former prime minister had written in his memoirs he has constantly regretted not going further and faster in his public service reform programme.

Cameron was speaking after delivering a major speech on public services reform ahead of the NHS reform bill this Wednesday and an education bill next week. He admitted parts of the public were rolling their eyes at the prospect of another government promising to transform public services.

He is also under intense public pressure to reassure the public that the NHS reforms are wise at a time of spending restraint, as well as to show how the scale of the reforms were openly trailed by the Conservatives in opposition. He argued that unless he pressed ahead with reform, a form of institutional inertia would take hold.

He denied he had misled the public ahead of the election by promising he would not introduce another top-down NHS reorganisation, arguing that his modernisation was being driven from below by the needs of GPs and patients. Downing Street has decreed that the NHS changes are described as modernisation and not reform.

In the question-and-answer session following the speech at the Royal Society of Arts in London, he denied he had intended to describe the NHS as second rate, as he had in an interview on BBC Radio 4's Today programme, saying he meant to say second best.

But he insisted there was a problem in that the NHS was receiving near-European style levels of spending yet the quality of care in cancer, strokes and heart attacks fell short.

He said at present in the NHS there was not enough incentive to improve health outcomes and promised he wanted to do more to ensure that measures of patient satisfaction were included in any future assessment of the NHS.

Cameron's speech was designed to provide an overarching context to the public service reforms being introduced by the government, as well as to reassure the public's doubts about what some fear is a near-Maoist style revolution in public services, repeatedly insisting he was not being driven by an ideology except the improvement of the quality of user care.

He argued his reforms to the NHS were very different to those that had gone before since they were not being imposed by bureaucrats at the centre.

He also claimed the health unions, now mounting a strenuous protest over the reforms, felt duty bound to resist change even when in the hearts they knew the change was necessary.

He said the four big public concerns about reform were: "How can we modernise public services when there is so little money? Why do we believe there is a real prospect of our succeeding in modernising public services when many others have not? Won't there be losers from the changes we make, and finally do we have to make all these changes so fast so soon?"

In the case of healthcare he said the need to deal with inefficient supply, and ever expanding demand meant the government had no choice but to introduce change at a time of lower spending.

He insisted he believed his package of reforms will work since he had really tried to learn the lessons of the past. He said the Major and Thatcher governments had understood the need to introduce choice but there had been insufficient respect for the ethos of public services and public service."

The problem under the last Labour government was the opposite, Tony Blair had introduced foundation hospitals and academies "but did so while maintaining a whole architecture of bureaucracy and targets and significantly understating the valuable role of charities and the voluntary sector".

He said the lessons from the past are clear: "The right were guilty of focusing too much on markets and the left were guilty of focusing too much on the state. Both forgot the space in between society."