The Conservative MP Sarah Wollaston has previously likened Andrew Lansley's NHS reforms to throwing a "grenade" into the health service. Today, she launches a similarly explosive device at David Cameron.
In an op-ed piece for the Sunday Telegraph, Wollaston, who was a GP until last May, calls for dramatic changes to the government's Health Bill to "regain public and professional confidence". Along the way, she provides Ed Miliband with plenty of ammunition for future PMQs.
Wollaston describes the reforms as a "Trojan horse", warns that important elements of the reorganisation are "completely unrealistic" and "doomed to fail", and says that the NHS could be changed "beyond recognition". One should add that she rebuts Cameron's rhetoric more effectively than many on the opposite side of the House. She writes:
At Prime Minister's Questions last week David Cameron said: "We are not reorganising the bureaucracy of the NHS, we are abolishing the bureaucracy of the NHS."
That is part of the problem.
It is one thing to rapidly dismantle the entire middle layer of NHS management but it is completely unrealistic to assume that this vast organisation can be managed by a commissioning board in London with nothing in between it and several hundred inexperienced commissioning consortia.
Taking aim at the centrepiece of the reforms, Wollaston argues that GPs are neither willing nor able to manage £80bn of the £100bn NHS budget. David Cameron may dismiss the British Medical Association, which has called for the government to withdraw its bill, as just another "trade union", but he will struggle to ignore the criticisms of one of his own MPs.
Cameron is too committed to these reforms personally to attempt a forests-style U-turn. Lansley will be spared the Spelman treatment. But following the decision to abandon price competition, I'd wager that the coalition will look again at the "any willing provider" rule and at the decision to place the NHS under EU competition law for the first time (something Cameron seemed only vaguely aware of at PMQs).
Lansley's ideological blueprint may not survive contact with reality.