John Rentoul: Lansley's Bill is safe, but he is not

The NHS shake-up is past the point of no return, and will proceed. Its author's future is less assured

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Having spoken to many well-placed sources I conclude that the health Bill is not going to be dropped. Which is a strange coincidence, because that is what my well-placed sources tell me. Quite often, it is safer to assume that the opposite of what people in government say will happen is what will actually happen. But in this case, there are good reasons for thinking that the Bill will survive.

The Bill itself ceased to matter some time ago. It has been diluted so much that it has become part of a controlled trial to see whether homeopathy should be offered on the National Health Service. So while "Kill the Bill" is short, assonant and sounds as if Uma Thurman is in it, it will not be showing soon on a screen near you. Much excitement was generated by a trailer for this non-existent film on Friday by Tim Montgomerie, editor of the Conservative Home website.

His article was entitled, "The unnecessary and unpopular NHS Bill could cost the Conservative Party the next election. Cameron must kill it." But actually he argued in the text for "removing all contentious components of the Bill". That has already happened. Job done.

So the Bill will resume in the Lords tomorrow. It has almost finished its parliamentary stages, and it is not like the welfare reform Bill, which is now in "ping pong" between the Commons and the Lords. The Liberal Democrats in the Lords support the health Bill because Shirley Williams was taken to one side and asked to name her price. Nobody understood what she wanted, but they wrote it down and put it in the Bill. It didn't make much difference to the Bill, because Andrew Lansley had written that and no one understood it either, but the Liberal Democrats are happy and the Bill will go through.

Why, then, is it so unpopular? To answer this question you have to understand the politics of the NHS. This rests on these axioms. One, everyone loves the NHS. Two, everyone agrees that the NHS must be run more efficiently, to keep up with rising costs, the ageing population and, now, the slower planned growth in NHS spending. Three, any changes that impinge on the interests of people who work in the NHS will be condemned as privatisation, especially if they are nothing of the sort. Four, everyone will agree that this is the end of the UK as a civilised society/enough to make Nye Bevan spin in his grave/quite simply a disgrace. Five, the media will move on and eventually start again at step one.

Now, this cycle can be repeated indefinitely under Labour governments, because everyone knows that the NHS is Labour's greatest achievement and no one is allowed to point out that if the Conservatives had designed the NHS in 1948 they might have brought in something more like the social insurance model that tends to produce better results in continental Europe.

But under a Tory-led government, there is a danger that old wounds inflicted by Margaret Thatcher will re-open. That is why No 10 declared a medical emergency last summer. To save the Tory brand from retoxification, the Bill's progress was paused. This was a compromise between two halves of David Cameron's brain. George Osborne, the realpolitik half, wanted to abandon the Bill; Steve Hilton, the inertia-is-death half, wanted to press on. Cameron had been jolted by Andrew Cooper, the pollster who had just joined Downing Street, who reported how suspicious the voters were of Tory motives. Hilton argued that if public opinion was against the Bill, the Government should try to shift it, rather than giving in. So, although the pause seemed to be a compromise, Hilton had won, because the pause was part of trying to shift opinion. "We have to prepare the argument better," was the lesson learnt by one of those closest to the Prime Minister.

There was only one problem with that plan, which was that it depended on Andrew Lansley, the Secretary of State for Health , to carry it out. As was reported last week, the troubleshooters sent in by No 10 to write his speeches for him were frustrated by Lansley taking their draft and inserting his speaking notes, of which this is a genuine sample from the published text: "GP/community/acute/ LAs/safeguarding/children's trusts. Not structural integration but integration around families and children. Marmot (universal proportionalism) – early intervention." So although Hilton won the battle, Lansley lost the war.

The moment when the Bill could have been dropped was last June. Since then, every informed observer has pointed out that a new law was not really needed, and that the reforms could have been sold simply as intensifying the best of what Labour had been doing. But it is too late now. And it is too late for Lansley. If the Bill had been ditched in the summer, he might have survived.

But the advantage of keeping the Bill, from the point of view of achieving clarity in Cameron's brain, is that it has allowed a scientific experiment to take place. The Bill was unpopular when it wanted to hand over most of the NHS budget to GPs in Blairite choice-and-decentralisation-gone-mad. Now that it has been thrown into reverse it is even more unpopular. The experiment has shown that the Bill is not the problem.

The one conclusion to be drawn is that Lansley is the problem. He is not a good communicator. As Cameron knows full well, being a poor communicator is not a trivial deficiency in modern politics. When you are running something as big as the NHS, everyone in it and the taxpayers who pay for it need to know what you are doing to make it better.

The Bill no longer matters. The only way Cameron will turn perceptions of the NHS round is by appointing a new Health Secretary. Someone who can be charming to the royal colleges, pay homage at the shrine of Clement Attlee and Nye Bevan and promise in plain English to give power to patients. Call for Michael Gove.;

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