Jeremy Laurance: A high-risk strategy, but Lansley is in a hurry

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If it ain't broke, don't fix it, is a useful maxim for a politician – but not apparently for Andrew Lansley. The NHS is enjoying its greatest ever year, with the highest spending, shortest waiting lists, lowest deaths from cancer and heart disease, and record levels of satisfaction (according to this week's British Social Attitudes survey). Yet the Health Secretary is determined to yank the service up by its roots – for the umpteenth time.

It is a high-risk strategy, as just about everyone involved, from the chief executive down, is telling him. As the Health Select Committee pointed out yesterday, securing efficiency gains of the kind required – 4 per cent a year over the next four years – has never been achieved by any health service anywhere in the world. Yet Mr Lansley expects the NHS to pull off this miracle while simultaneously achieving another – switching control of the bulk of the NHS budget from managers to GPs.

The jitters in Government can already be felt. Mr Lansley's reform plan is being scrutinised by Oliver Letwin, the Cabinet's fixer, and publication of the Health Bill has been delayed until next year.

So why is Mr Lansley committed to the path of maximum disruption? Because he is determined not to repeat the 1997 Blair government's mistake by delaying reform and then finding there is too little time to implement unpopular changes before the next election.

It puts one in mind of the First World War general who declared: "Casualties: huge. Ground gained: negligible. Conclusion: press on."

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