Soap Box: Alex Challoner, MD, Cavendish Communications

When the coalition Government was formed in May 2010, public satisfaction with the NHS was at record levels.

Alex Challoner: Cavendish Communications MD
Alex Challoner: Cavendish Communications MD

On top of this, in the general election, David Cameron promised no-top down reorganisation of the NHS. So why introduce a reform programme so vast?

The decision to make major changes to the NHS was taken during the coalition's honeymoon in the summer of 2010, when reforms were being launched in education and welfare and Cameron thought he might as well add health. He was determined to heed the lesson of Tony Blair, who didn't start on changes to the NHS until his second term and regretted that he had left is so late. The Prime Minister also trusted Andrew Lansley.

So what has gone wrong? Two things: timing and implementation. Reform conceived in an era of public sector plenty has reached fruition at a time of record spending cuts.

Not only did the Government do nothing to address the pressing short-term imperative to make savings, it made matters worse by ushering in a huge structural upheaval with all its attendant costs.

Lansley's inability to find a compelling answer to how the reform will make life better for patients has done most to undermine his own position and that of the Bill.

What happens next? A concerted effort by the Prime Minister to come out fighting for his Health Secretary. Number 10's calculation is that the damage done to the Prime Minister's reputation by a full retreat would be so extensive that he has no choice other than to get the Bill on the statute book by the spring.

After that is done, Cameron will have to work out whether he wants to continue with Lansley after the reshuffle expected later this year.

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