Creeping privatisation? Or a case of simply doing what is practical?

The Cabinet's loosening of rules on district health boards farming out non-urgent surgical operations to private hospitals is the logical step to take for a Government trying to get more from less.

National wants more convenient healthcare, less bureaucracy, shorter waiting times for surgery and a motivated medical workforce, while at the same time cutting the size of the annual cash injections which have largely failed to produce any of those things.

The solution? The market. But not yet, thank you. Monday's decision is a step towards public and private providers eventually competing for the health dollar, thereby (in theory at least) providing more operations more cheaply through increased efficiency and higher productivity.

But so far, National has taken only a step in that direction - a step writ large in its election manifesto. So, no shocks. For that and other reasons, the Prime Minister's announcement attracted little attention despite its significance.

For some time, health boards have been contracting out non-urgent procedures when they have needed to meet targets for elective surgery, mop up unspent cash at the end of the financial year, or have been given extra money for operations but lack the capacity to do them.

Giving the boards more flexibility to contract out non-urgent surgery rather than having to resort to "spot purchasing" - so the argument goes - will save money. This is because private hospitals will have plenty of notice to ready operating theatres and staff rather than operations being done on an ad hoc basis.

If that is cheaper and shortens waiting times, then who is going to complain about publicly-funded operations being done by private hospitals.

It all fits John Key's prescription that his Government is interested in things which work - not what party ideology decrees. It all looks like a win for everyone - a perception that Health Minister Tony Ryall is keen to see gain widespread currency.

The few plaintive cries from the likes of the senior doctors' union focused on the likelihood of already-scarce medical staff drifting away from public hospitals to better pay and conditions in private ones.

In Parliament, Green MP Kevin Hague slammed the policy as ideologically driven. It would undermine the public hospital system, while satisfying its private counterpart which has been lobbying for a greater share of state-funded electives.