In his first address to the Conservative conference as leader four years ago, David Cameron noted that while it took Tony Blair three words to sum up his priorities for government ("Education, education, education"), he could do it in three letters: "N-H-S". There is little doubt that Mr Cameron has great admiration, approaching awe, for the men and women who work for and in the National Health Service; his attachment is especially strong because of the care and support given to his late son, Ivan, during his struggles with illness and disability. It is all the more curious, therefore, that he has sanctioned his Health Secretary, Andrew Lansley, to propose a raft of changes to the NHS within the first 100 days of the coalition government. These changes represent not just bad policy, but bad politics.
Mr Lansley's plans - detailed in a white paper presented to the House on 12 July - would result in the abolition of England's ten strategic health authorities and 152 primary care trusts (PCTs). In their place the country's 56,000 GPs would be expected to form roughly 500 consortiums responsible for an £80bn care budget, the vast proportion of NHS spend. The ambition is to have all this in place in 2013.
This is bad politics because it is an unnecessary risk. The coalition is already committed to real-term increases in NHS spending - a legacy of a Tory pre-election promise that also looks increasingly unsustainable when other Whitehall departments are facing cuts of up to 40 per cent. So why embark on yet another major reorganisation? At that 2006 party conference, Mr Cameron promised that there would be "no more pointless reorganisations", and the coalition agreement, reached less than two months ago, pledged to "stop the top-down reorganisations of the NHS".
Yet make no mistake; in spite of the rhetoric, this is another top-down reorganisation of England's health service. It is deeply flawed. For a start, there is no evidence that the bureaucratic load would diminish. Health authorities and PCTs would be replaced by the NHS Commissioning Board and the GPs' consortiums: in effect, two decision-making bodies separating the Department of Health from providers of care would be replaced by . . . two more tiers of management.
Moreover, the proposed regime introduces a potential conflict of interest. General practitioners would become both service provider and service purchaser. As with Michael Gove's plans for the introduction of free schools, the ideological drive for less management is not matched by guarantees of accountability or specific funding commitments. Mr Cameron's coalition partners in the Liberal Democrats wanted to give patients a stronger voice by introducing elections to primary care trusts. That idea has gone the way of the PCTs themselves.
Further, there is no evidence that GPs want this responsibility or have the skills to fulfil the task. "I can't read a balance sheet," one GP wrote in the week Mr Lansley announced his plans. Undoubtedly she is not alone. If GPs lack the desire or the expertise to operate in this way, the gap would inevitably be filled by private firms. No wonder there is talk of "denationalisation". These reforms would result in unnecessary, unwanted and creeping privatisation of our health service.
If this is a cost-saving exercise, there is no guarantee that it would be a cheaper alternative - quite the reverse, in fact. Civitas, a think tank with solid right-of-centre credentials, warned that the proposals represent a "huge structural change" and come at significant cost. Calculations by the Health Service Journal suggest the new model could cost £1.2bn more than the current one.
Andy Burnham, Mr Lansley's predecessor and his current shadow, was entirely correct when he characterised the overall package as "a giant political experiment with no consultation, no piloting, no evidence". Or, to steal the words of Mr Cameron, a pointless reorganisation