Tom Richmond: Poor bill of health for our political leaders

Yet, while Margaret Thatcher and Tony Blair could fall back on commanding Commons majorities, the PM does not have that luxury – he has to keep the Liberal Democrats on board, and they’re still licking their wounds over student tuition fees.

There is also another factor at play. The tug-of-war over the National Health Service masks the mediocrity now governing Britain.

Cameron, unable to win a Tory majority at the last election in spite of Labour presiding over a deep slump, appears to be relatively secure because of the Opposition’s ineffectiveness.

Equally Ed Miliband has only survived this long because the Government has handed him a succession of political gifts – such as tuition fees and the NHS.

It is not a scenario to inspire confidence, or effective reform of key public services.

That said, communication appears to be one of Cameron’s greatest difficulties – a somewhat ironic conclusion given his public relations background.

Take tuition fees. Even though the cap, brought in by Labour, was raised to £9,000 a year, safeguards championed by the Lib Dems means no graduate has to pay back a penny until they start earning £420 a week, at which point they become liable for £16.

Furthermore, the number of university applications submitted by pupils from deprived background has fallen by no more than half of one per cent.

Yet Ministers have lost the argument – even though their plans reflect these austere times and the belief that students should not receive a blank cheque from taxpayers.

It is the same, but on a far greater scale, with the NHS where Labour’s spokesman Andy Burnham – one of the men who headed the Department of Health under Gordon Brown – is getting away with desperate opportunism as he evokes the memory of Nye Bevan.

His charge is this: “The Coalition inherited a successful, self-confident NHS and in just 18 months they have turned it in to an organisation that is demoralised, destabilised and fearful of the future.”

It’s powerful language, almost as powerful as Blair declaring prior to the 1997 election that the nation had 24 hours to save the NHS or Cameron saying his leadership could be summised by three letters: NHS.

Yet Cameron’s counter-argument – a reformed Health Service that still offers “health care for all, free at the point of use, unrelated to the ability to pay” – is lost because of doubts about the competence of Andrew Lansley, the Health Secretary, and Labour’s ability to play on people’s fears about privatisation.

However the Prime Minister, and the Liberal Democrats, should have nothing to fear from defending the principles that they started to articulate with impressive clarity after the political pressure on Lansley intensified. After all, politicians and patients agree that productivity, and the quality of care, will have to improve – the limited increase in spending is more than offset by inflation and the cost of an ageing society.

Firstly, every patient believes doctors and nurses should have a greater say – one of the three tests that Cameron set out. The cost of running primary care trusts and strategic health authorities rose by 23 per cent under Labour – and Burnham had to plead ignorance when challenged in the Commons about a report, commissioned on his watch, which revealed the number of managers was rising three times faster than the number of nurses. Agreed?

Secondly, the NHS bureaucracy is wasteful – and everyone knows it. I’ve got an appointment at 8.30am next Monday. My notes will pass between at least four different people before I see the consultant. Why? “Because we’ve always done it this way,” I’m told. There has to be a better way of running the NHS – whether it is cutting the paper-shufflers or more enlightened decisions on the allocation of resources. Again, where’s the disagreement?

And, finally, hardly a day passes without another report warning of an obesity timebomb – or the consequences of binge drinking. As Cameron points out, hospitals are on the receiving end of people’s personal irresponsibility – but it is up to politicians to change habits for the better. The scope for savings is limitless. Anyone disagree?

If the PM can pull these strands together, he can save his Bill. But the problem is that Burnham’s scare-mongering is unchallenged, such as this claim: “It is inescapable that this is the wrong time to re-organise the NHS.”

It is a flawed argument. For, when taken to its logical conclusion, when is good time to reform the NHS? Only when Labour are in power? And that is the problem. The Health Service has enjoyed sacred status for so long that delay only makes the surgery even more painful when the time for reform comes.

Belatedly, Tory chairman Sayeeda Warsi – and then Cameron himself – have woken up to this. They have started making the case for reform. Their problem is that they promised no top-down reorganisation of the NHS prior to the election. Again, they only have themselves to blame. For, if their medicine is evolution and not revolution, as they contend, they did not have to portray their plans as a massive shake-up to prove their reform credentials.

And it is only because of this tactical failure – symptomatic of political inexperience – that Ed Miliband and Andy Burnham, members of a government that wasted vast sums on the NHS, now have a chance to derail the health reforms and allow current inefficiencies to remain.

Is this the best that our political elite has to offer? I hope not. For the sake of the National Health Service, patients and all taxpayers.