Andrew Grice: Cameron learns from mistakes and tightens his grip over his ministers

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Cabinet "colleagues" are not shedding too many tears for Andrew Lansley, the Health Secretary, who is getting most of the flak for the mess the Government is in over his controversial NHS reforms.

Although they admit he is a master of the detail, some ministers believe he deserves his come-uppance because he ignored the warning signs and ploughed on stubbornly with his shake-up, losing the public's support when it saw he had failed to take the health professionals with him.

However, a more rounded verdict is taking shape in other Cabinet minds. Some of David Cameron's natural allies believe the Government's health problem stems as much from the Prime Minister's style of government as the complacency of the Health Secretary. Like the U-turn over the mad attempt to sell off England's public forests, the NHS controversy has shed light on the Coalition Government's main weakness so far – the absence of a strong enough centre at Downing Street.

Mr Cameron has read Tony Blair's memoirs as closely as anyone and drew one big lesson: not to waste his first term and to crack on quickly with his reform agenda. Hence the frantic pace on health, welfare, education and the police. But Mr Cameron missed another crucial lesson: the need for Number 10 to keep a grip on Whitehall departments.

All the headlines about the top-down government and control freakery of Mr Blair and Gordon Brown led Mr Cameron down the wrong track. As Leader of the Opposition, he resolved to be a rather laid-back chairman of the Cabinet board, not a hands-on chief executive who would micro-manage every move by his departmental ministers. Letting them get on with it would also mean the Tories would not need the party- political henchmen recruited by Labour and funded by taxpayers. Again, the Tory leader believed the headlines he had inspired: those nasty spin doctors would be pruned. He promised his government would have fewer special advisers than Labour.

Mr Cameron knows now he made two mistakes. The row over forestry exposed an underpowered Number 10 operation. Because he had slimmed down the Blair-Brown policy unit, the handful of players left could not possibly man mark 16 Whitehall departments.

Mr Cameron's second error was to expect too much of politically neutral civil servants. "In opposition, he was convinced that there was a Rolls-Royce machine, which had been corrupted by Labour's political appointments and would swing smoothly into action once we were elected," one aide told me.

He was wrong. As Mr Blair could have told his student: "You pull the levers, and nothing happens." Egged on by Steve Hilton, his strategy guru, Mr Cameron vented his frustration at the civil service in a speech to the Tories' spring conference in Cardiff last month. He branded foot-dragging, regulation-loving bureaucrats as the "enemies of enterprise," in an echo of Mr Blair's "scars on my back" speech two years after coming to power.

Mr Cameron's speech, too, was a mistake. It went down very badly throughout Whitehall, where there was a lot of goodwill towards the Coalition despite the pressure for spending and job cuts. The Prime Minister adopted a very different approach on Wednesday as he tried to woo NHS staff, oozing praise for their heroic work. Another painful lesson learnt.

Some of the antics of Labour's political advisers were foolish but political engine drivers are needed to crank the Whitehall machine into action and chase progress. Mr Cameron will soon be forced to admit the Coalition has more special advisers than Labour had, though it will be no great scandal in itself. They are a vital link between ministers and civil servants.

Mr Cameron had already learnt from his early mistakes before his wobble over the health reforms hit the front pages. He has beefed up the Downing Street policy unit, mostly with civil servants rather than political appointees. Andrew Cooper, like Mr Cameron a graduate of the Conservative Research Department, has been recruited as Number 10's director of strategy.

The new faces are charged with spotting ministers' unforced errors before they become public and preparing the ground for policy launches so they don't come as a nasty shock and provoke a firestorm. Mr Lansley failed to do so on health. In contrast, Iain Duncan Smith got full marks from Team Cameron for "rolling the pitch" before unveiling his welfare reforms, by serving up an almost daily diet of tabloid stories about alleged abuse of the system. However, he was batting on a much better wicket than Mr Lansley: the public doesn't like welfare scroungers, but it loves its NHS.

The shake-up at the heart of Government won't necessarily mean that Mr Cameron's problems are over. Insiders admit the intense pressure to turn headline cuts into real ones will lead to more mistakes. Both the forestry sell-off and the health reforms were in part driven by the need for savings. Others are bound to follow.

After almost a year as Prime Minister, Mr Cameron is realising that the job is much harder than he imagined in opposition, when his small, tight-knit team could drive everything from the centre. His new team will be tested to the limit in the next 12 months. "We cannot afford another cock-up like the health reforms," one Cabinet minister admitted.

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