After clear pre-election pledges of no “structural upheaval” in the health service, the Conservatives are now doing precisely the opposite, trying to force through a complex and little-understood overhaul which would sweep away management structures and give more power to GPs. As a result, Mr Cameron is earning the hostility of health workers and fostering confusion and a sense of betrayal among the public.
To make matters worse, however, the need to cut the public-sector deficit means that the NHS must deal with much smaller increases in funding, even though the overall budget is being protected. Consequently, although the Government dearly wants job cuts to come at managerial level so as to honour its promise to protect frontline staff, many health trusts clearly have other ideas.
The Royal College of Nursing points out that, of 10,000 job cuts across NHS trusts in England, 54 per cent will be clinical posts, including doctors, nurses and midwives. This is not only deeply worrying from the point of view of patient care, it is also very damaging for the Government.
Of course, without greater transparency in health-trust finances, it is impossible to judge whether these job cuts really are inevitable or whether clinical posts are being sacrificed in order to protect the vested interests of management.
But this is not Mr Cameron’s immediate worry. His prime problem is that, on an issue on which he staked his political future, that of protecting the NHS, he is increasingly perceived as dishonest and unreliable.