John Rentoul: Labour has a nasty dose of self-delusion

The coalition is unpopular, but a lack of policies will wipe out any gains Ed Miliband makes in this week's local elections

Howard Stoate was briefly more famous last week than he ever was in his blameless 13-year career as a Labour MP. The Prime Minister was reading out an article that the GP, who stood down as an MP last year, had written when the parliamentary yah-boo balloon went up. David Cameron's full words, responding to barracking from the Opposition, were: "Calm down, dear. Listen to the doctor."

Jonathon Green and Jane Merrick analyse the significance of his riposte on the previous page, but here I want to look at a different issue: what was the shouting match actually about?

Ed Miliband had asked about NHS waiting lists, some of which are rising again. The Prime Minister said that other waiting lists were falling, and then wanted to quote Stoate in support of Andrew Lansley's changes to the health service. As Hansard drily records, in square brackets, there was then an "Interruption". After the fuss had subsided, Sarah Wollaston, a Tory backbencher, said she was concerned that the changes would be disastrous, disruptive and have unforeseen consequences. Thus, on the substance of the issue, we had a Labour former MP who is a GP in support of the Government and a Tory MP who is a GP against.

No wonder people are baffled about what the Government is trying to do with the NHS, and no wonder so many people resolve the apparent paradox by assuming the worst. Peter Riddell, formerly of The Times, has written a book, published this month, called In Defence of Politicians. I would say that Sisyphus had the easy job by comparison – at least he almost got the rock to the top of the mountain each time. Even allowing for the depths of mistrust into which politicians have fallen, however, the Government's inability to make its case is pitiful.

It is notable that Labour people are better able to make the case for the changes than either Lansley or the Prime Minister. For we should make no mistake: Stoate is a strong and effective advocate of the reforms. He tried to confuse the issue by writing another article in response to Wednesday's furore, accusing Cameron of quoting him misleadingly. His main objection seemed to be, however, that the Prime Minister failed to give the Labour government sufficient credit by insisting that the changes were a continuation of Labour's reforms. And he defended the proposals against the charge that GPs will neglect their surgeries to run the NHS bureaucracy: "GPs will continue to see patients every day, but will ally their perception of patients' needs with their knowledge of the health service in order to create better services."

At least it is an argument in normal English, even if there may be an element of vested interest in play, as GPs see their chance to seize control of the NHS. I suspect, though, that the Lansley plan lies somewhere on the spectrum between right in principle and irrelevant. Alan Maynard, professor of health economics at York University, is the main proponent of the "irrelevant" thesis, saying that the many "re-disorganisations" of the NHS since 1974 have changed the signs outside hospitals, without any evidence of improvement, but that they keep politicians and the media entertained.

That said, Lansley's inability to explain what he is doing is now becoming a serious part of the problem. He gave an interview last week in which he talked about local councils being "early implementers of the health and wellbeing pods" and, after saying some more words that sounded as if they had been shaken at random from a team-bonding exercise, left the room. His minder said, in words that may become his political epitaph: "I don't think he's coming back."

As the coalition approaches its first anniversary, the trouble with the NHS changes ranks as one of the two big policy disasters of Year One, the other being the tripling of tuition fees. What links the two is that the voters were not told about them before the election, as Tim Bale writes in this month's Parliamentary Brief: "It is this manifest failure on the part of both partners in the coalition to have levelled with the electorate either before or during the campaign that has overshadowed and undermined everything they have tried to do."

This gives Labour false confidence. Because however much difficulty the absence of a mandate causes now, the next election will be a verdict on the next four years not the last one. This week's local elections also risk inflating Labour. The party's status as the only national opposition party will be confirmed as the spoils of the Lib Dem collapse in local councils fall into Ed Miliband's lap. Only Alex Salmond's likely victory in Scotland can dent Labour delusion.

The NHS and tuition fees disasters have another feature in common that make them far less threatening to Cameron at least – I'll come to Nick Clegg in a moment – and that is that the Opposition has no alternative. Miliband's policy is not to do this, or that, and to cut public spending more slowly. On tuition fees, his unworkable graduate tax has already been forgotten. On the NHS, he mistakes pointing out that some waiting lists are rising for a strategy.

As ever, things are more complicated than the yah-boo of the Commons will allow. The fall in waiting lists levelled off in 2009, before Lansley foolishly abolished the targets. Which is a reason to think that the NHS will muddle through, on the Maynard model, regardless of what the politicians decree, not least because NHS spending is protected.

This last point shows that Cameron knows his history. He is not a right-wing Thatcherite bent on the destruction of everything that the Labour Party holds dear, but the opposite. He is a true Conservative who understands the party's genius for adaptation and survival. His is the Tory party that co-opted and swallowed the Liberal leadership in 1922 and 1931. His is the party that swivelled round with the minimum of fuss to support the Clement Attlee postwar welfare state and presided over its golden years in the 1950s.

Now the Conservatives have done it again. They have not just absorbed the Liberal leadership as their voters flee – and it is hard to escape the conclusion that the Lib Dems are doomed in 2015 – but they have sought to neutralise the Labour advantage on the NHS by guaranteeing its spending in real terms. This is an expensive promise that will become more striking when the cuts start to bite in other departments over the next few years, which will allow Cameron to point out repeatedly that Labour refused to match the guarantee at the last election.

The Labour Party should have taken Cameron's advice last week, instead of allowing itself to be distracted by a patronising phrase, and listened to the doctor. Stoate should be a warning to them that, however much of a mess Lansley makes of it, the NHS is not the favourable ground that Labour thinks it is.

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