If the opinion polls are accurate, the public's level of trust in the coalition's management of the NHS is perilously low. In truth its record is an unenviable one: from the torturous passage of the Health and Social Care Bill to the souring of relations between the Department of Health and clinical groups, ministers have seemed out of touch at best, and incompetent at worst.
It is not surprising that senior Conservatives are already developing political and electoral strategies to rehabilitate the party's reputation on the NHS before the next election. Aware that voters will place the blame for the NHS' problems over the next three years on Conservative - rather than Liberal Democrat - shoulders, party insiders know swift action is required.
In opposition, David Cameron dedicated almost five years - and extensive political capital - to restoring public confidence in his party's ability to manage the NHS. By talking openly about his personal experiences of relying on the NHS, and committing to increase its budget over and above Labour's spending plans, Cameron was able to secure the Conservatives a poll lead on the NHS for the first time in a generation.
To capitalise on this success, and prove the party could be trusted to manage the NHS, the Conservatives insisted during their coalition negotiations with the Liberal Democrats that they should lead the Department of Health. But when Andrew Lansley announced his radical plans for the NHS, after seven years of preparation, the party's ratings began to plummet.
A resurgent Labour Party, while failing to make significant headway in the polls overall, now has a doubledigit lead on healthcare and an effective team of shadow health ministers working to erode the Conservatives' credibility on the NHS. Labour is almost certain to capitalise on this by running aggressive local election campaigns on the NHS over the next three years, and to ensure the coalition's record on healthcare forms the centrepiece of its election campaign.
Conservative strategists are aware that time is running out to prevent the party's record on the NHS from becoming a toxic issue that will cost it a majority at the next election, or, at worst, lead to an electoral disaster.
Number 10 has already intervened in the Department of Health's day-to-day political comms, overriding Lansley's special advisers and vetting all major policy announcements. As the gravity of its position dawns on the party, expect Cameron to sideline the Health Secretary and assume a more prominent role in selling his party's NHS credentials.
At some point Cameron will be forced to remove Lansley and some of his team from the health brief, either to another department or retired to the backbenches. Recruiting a fresh-faced, new Conservative team to the Department of Health, insiders believe, is the only way to restore public confidence in the party's NHS policy.
As the general election draws closer, expect the Government to divert att-ention from its controversial structural reforms with a wave of popular announcements on issues aimed at improving patients' day-to-day experiences of the NHS. Action to reduce waiting lists, enhance patients' rights to choose their doctors, or lower prescription charges seem likely.
Whatever the success of these manoeuvres, the Conservatives will choose to fight the next general election on the economy, not the NHS. Given recent opinion polls, however, it will be the state of the NHS, as much as the state of the economy, that determines who forms the next Government.
Views in brief
Which patient group has deployed the most effective comms strategy?
The Rarer Cancers Foundation campaign for a Cancer Drugs Fund was an evidence-based campaign that facilitated strong relationships with politicians while remaining focused and impartial through a general election. It culminated in a race between Labour and the Conservatives to announce the policy first.
What must you consider when devising a strategy to communicate risk?
Do not leave any ambiguity about the facts of your message. Say as much as you can, say it as quickly as possible and remember that patients come first so put yourself in their shoes and choose your channels wisely.