Leading article: NHS pledges with a political purpose

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David Cameron was confident and fluent in his keynote speech on the NHS yesterday but its content did not add up to much. The five pledges he made were anodyne: he wants to spend more, keep waiting lists low, improve integrated care not hinder it, and all the rest. He could hardly have said the opposite.

The aim of the speech was transparently political. The Prime Minister needs to calm the troubled waters into which the Coalition's health reforms have recklessly steamed. Despite undertakings from ministers that "substantial and significant" changes will be made to the plans, the criticism from health service professionals and others continues. Clear divisions have opened up in the Coalition on the way forward. Mr Cameron was yesterday trying to steady the ship by moving away from the nuts and bolts of reform and turning the issue into one of trust in his own commitment to the NHS.

Everyone agrees there are big long-term issues facing the service with an ageing population and the rising cost of treatments. There can be arguments about whether the plans of the Health Secretary, Andrew Lansley, to give a much greater role to GPs and the private sector, will help or hinder the NHS in the medium-term. But it is notable that the British Medical Association, whose members stand to profit most from GP fundholding, want the legislation scrapped entirely.

What is clear is that all this is only adding to confusion and uncertainty in the short-term – just as the NHS is being asked to find £20bn in savings. This is not a good time for an organisational upheaval. If Mr Cameron is serious about decontaminating the Tory reputation on health he needs to understand this. The "real changes" he announced yesterday are not sufficient. Dropping Mr Lansley's macho 2013 deadline is sensible, but the reassurance that greater competition will only be introduced when it benefits patient care and choice begs the question of what it was designed to do before. Confusion over the new NHS economic watchdog, Monitor, persists. Mr Cameron has invited the electorate to hold him "personally accountable" on the NHS. He should know that it certainly will.

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