The pressure rises on Andrew Lansley

The Health Secretary failed to rebut the charge that his reforms are "a disruption and a distraction

The coalition's decision to embark on the biggest reorganisation of the NHS in its history always sat uneasily with the need for the service to make record efficiency savings of £20bn. Indeed, the project was once succinctly described by the British Medical Journal as "mad". Now, the health select committee, chaired by the former Conservative health secretary Stephen Dorrell, has warned that the reforms are acting as a "disruption and distraction" and are hindering the NHS's ability to make savings. The committee argues that the health service is relying on short-term cuts and "salami-slicing" to save money, instead of re-thinking the way care is delivered. It all sounds much like the "perfect storm" that Hamish Meldrum, the head of the British Medical Association, spoke of in his interview with NS editor Jason Cowley in this week's magazine.

"It is self-defeating to cut services for patients in order to then re-invest to improve them", an anxious-sounding Andrew Lansley declared on the Today programme this morning (see below). But that is exactly what the Health Secretary stands accused of doing. Moreover, he failed to rebut the central charge that his reforms are undermining the NHS's attempt to save £4bn a year.

Lansley: NHS efficiency savings being done "the right way" (mp3)

David Cameron worked hard in opposition to convince the public that the Conservatives could be trusted with the NHS but it has become one of the biggest headaches for his government. Lansley's chaotic reforms have destroyed Cameron's ambition to depoliticise the issue. As Lord Ashcroft recently observed in his report Project Blueprint: Winning a Conservative majority in 2015, "nobody seemed to know why the reforms were needed and how, even in theory, they were supposed to improve things for patients." Just 20 per cent of voters believe that the NHS is "safe in David Cameron's hands" and Labour has established a 12-point lead over the Tories on health policy.

So, as Lenin asked, what is to be done? Lansley's opponents are determined to see the bill dropped but the widely-respected Dorrell insisted on Today that it was too late to go back. A dramatic U-turn would cause even more disruption, he suggested.

Lansley's own future is less certain. The Health Secretary has failed in the eyes of NHS staff and increasingly lacks the political authority needed to explain and defend the reforms. Should Chris Huhne's legal travails force Cameron to reshuffle his cabinet, he may well take an opportunity to move the discredited Lansley.

George Eaton is political editor of the New Statesman.

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Why relations between Theresa May and Philip Hammond became tense so quickly

The political imperative of controlling immigration is clashing with the economic imperative of maintaining growth. 

There is no relationship in government more important than that between the prime minister and the chancellor. When Theresa May entered No.10, she chose Philip Hammond, a dependable technocrat and long-standing ally who she had known since Oxford University. 

But relations between the pair have proved far tenser than anticipated. On Wednesday, Hammond suggested that students could be excluded from the net migration target. "We are having conversations within government about the most appropriate way to record and address net migration," he told the Treasury select committee. The Chancellor, in common with many others, has long regarded the inclusion of students as an obstacle to growth. 

The following day Hammond was publicly rebuked by No.10. "Our position on who is included in the figures has not changed, and we are categorically not reviewing whether or not students are included," a spokesman said (as I reported in advance, May believes that the public would see this move as "a fix"). 

This is not the only clash in May's first 100 days. Hammond was aggrieved by the Prime Minister's criticisms of loose monetary policy (which forced No.10 to state that it "respects the independence of the Bank of England") and is resisting tougher controls on foreign takeovers. The Chancellor has also struck a more sceptical tone on the UK's economic prospects. "It is clear to me that the British people did not vote on June 23 to become poorer," he declared in his conference speech, a signal that national prosperity must come before control of immigration. 

May and Hammond's relationship was never going to match the remarkable bond between David Cameron and George Osborne. But should relations worsen it risks becoming closer to that beween Gordon Brown and Alistair Darling. Like Hammond, Darling entered the Treasury as a calm technocrat and an ally of the PM. But the extraordinary circumstances of the financial crisis transformed him into a far more assertive figure.

In times of turmoil, there is an inevitable clash between political and economic priorities. As prime minister, Brown resisted talk of cuts for fear of the electoral consequences. But as chancellor, Darling was more concerned with the bottom line (backing a rise in VAT). By analogy, May is focused on the political imperative of controlling immigration, while Hammond is focused on the economic imperative of maintaining growth. If their relationship is to endure far tougher times they will soon need to find a middle way. 

George Eaton is political editor of the New Statesman.