Is there a solution to the Coalition's NHS problem?

By Tim Montgomerie
Follow Tim on Twitter.

Up until the last election I had my doubts about the implications for other Whitehall budgets of the NHS spending pledge but I understood the politics. Cameron wanted to neutralise the NHS as an issue by spending more on it than could probably be afforded... but in doing so he could concentrate on other difficult areas of reform.

That strategy was then thrown out of the window when Andrew Lansley introduced his reforms during the Coalition's breakneck phase. After spending long years in opposition cuddling up to the professions and saying there'd be no reorganisation (although Lansley claims he was transparent) we were suddenly embarking on a very big reorganisation. The professions are now at war with Mr Lansley and he's fighting back - accusing them of obsessing about their pay and perks.

Nonetheless some Tories saw significant merit in the initial reform blueprint - notably Nick de Bois MP - but Lib Dem rebels led by Baroness Shirley Williams then got to work and diluted the reforms until the point they have become blunted and bureaucratic.

Further to Toby Helm's accurate leak in Sunday's Observer we have today the report of the Health Select Committee - led by former Tory Health Secretary Stephen Dorrell. The report concludes that the reforms are a "disruption and distraction" from the real challenges facing the NHS. Speaking to Radio 4 this morning Mr Dorrell rejected the tempting argument put forward by Steve Richards and many others that the Health and Social Care Bill should now be ditched. We can't go back, he said. He said a big u-turn now would only prolong the disruption.

It is at this point in a blog I normally try to say what I think should be done. Well, I don't know. It's all a terrible muddle and Cameron's ratings on the NHS are now a real political weakness.

One thing that probably does need to change is Andrew Lansley. The Health Secretary is a good man but he now lacks the trust of the NHS' staff and has been unable to explain his reforms to the public in an understandable way. A new Health Secretary could have something of a fresh start and set about focusing on the efficiencies recommended by Mr Dorrell or the four great reforms advocated by Ian Birrell.

An opportunity might present itself very soon. If, if, if Chris Huhne is forced to resign over speedgate the PM has an opportunity to address two of his Government's weaknesses - a Climate Change Secretary who is a block on getting a sensible policy on energy prices and a Health Secretary who lacks communication skills. I hope he takes it.