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 [2] 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 [3]" 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 [4] 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 [5] 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.

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 [7]: 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.