Can Lansley stay?

The Prime Minister, it seems, is now finally accepting what everyone else has been saying for a long time: that the NHS reforms were dangerous and would hurt the government. If Nick Clegg forced a re-think — even one that is supported by many Tories — then he may, in the end, play a greater part in delivering the next election for Cameron’s party than many triumphalist right-wingers now realise.

For CameronCare was badly-timed, poorly-delivered and strikes at the heart of the PM’s message that the Conservative Party can be trusted. Large-scale reforms need time. Time for people to accept a problem. Time for people to accept the solution.  Where the government has put in the graft, spent years highlighting a problem and then offered a solution, the reforms have been accepted. Think education, or welfare reform. But where reforms have been sprung on people — like the defence cuts — they are either obstructed or become a liability for the government. Health reform firmly falls into this category — whatever the merits of the actual reforms, which are considerable.

If the government is really going to junk the majority of Andrew Lansley’s reforms, then how can it not junk the Health Secretary? If ministerial duties can be defined, then surely creating a politically-acceptable process of reform is a key part. The thoughtful, knowledgeable Health Secretary has sadly failed in this regard. And sending an extra Special Adviser from No 10 to the Health Department is unlikely to help.

But, as his official pronouncements on the matter suggest, the PM will be reluctant to shift Lansley out. For if the Health Secretary has failed, so has Cameron — failed to spot the problems that were building up, and to run government in a way that allowed ministerial leeway yet some central control. And if Lansley were to be sacked, why not Vince Cable or Liam Fox, who have taken on the PM more directly?