Editor's blog Tuesday 3 May 2011: Permanent secretaries bet on the impermanence of Mr Lansley at health

I'm not sure whether Health Policy Insight was the first to predict that Secretary Of State For The Time Being Andrew Lansley would lose his Cabinet berth over the wretched mishandling of the politics, policy and presentation of the current efforts at NHS reform.

I think that we were first. I am sure that we have said it more consistently and more emphatically than anyone else.

As I pointed out last week, BBC Newsnight political editor Michael Crick blogged on this recently.

This evening, chief political correspondent of The Guardian Nick Watt joins the fray, reporting that the impermanence of Mr Lansley's position has become the subject of wagers among the permanent secretaries of Whitehall Village.

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Click here for details of 'Cameron the Winner; Lansley the Magnificent', via subscription-based Health Policy Intelligence.

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Watt rightly analyses the Lib Dems' need for substantial changes in response to their spring conference policy change setting them firmly against the reforms - as we pointed out in March.

He adds that PM David Cameron is influenced by the fact that "Andrew Cooper, his director of strategy who is a distinguished pollster, has made clear that he will risk heading into the next general election with poor poll numbers on health unless he acts".

Watt suggests that "the mandarins believe that removing Lansley – and probably his Lib Dem ministerial colleague Paul Burstow as well – will be the best way to demonstrate that the "listening exercise" is real".

He surmises that while the appointment of Stephen Dorrell to replace Mr Lansley looks obvious, all is far from settled. Watt concludes, 'If Lansley leaves the cabinet he might be tempted to point out that he was keen to explain his reforms which were included in the Tory manifesto. He was, however, blocked by Andy Coulson who feared unsettling voters on the NHS ahead of the election".

The prospect of a micturition contest between a defenestrated Andrew Lansley and a discredited Andy Coulson could sell a lot of ringside seats. (The prospect of colllateral damage means I'll probably watch the live stream.)

Either way, the politics of all this look very grim for Mr Lansley. His political failure to sell and tell the story means that he has become the story.

The likelihood is that (as Watt outlines) Lansley's scalp will be ritually offered up shortly after the close of the listening exercise, which is widely perceived to be a three-month affair (despite semi-official noises to the contrary). The most likely bet is that in just over ten weeks' time, That Nice Mr Cameron makes a Commons statement and Mr Lansley makes an exit from Richmond House.

Perhaps Crick is right, and the Downfall viral's prediction may come true: The Liberator might be offered transport.

I would not be sure, however. Mr Cameron is not a sentimentalist where loss of face is concerned - and he has already lost significant face politically, with his three-letter-defined political priority - NHS.

A price must be paid for that loss of Prime Ministerial face, and it will be paid.

However, Mr Cameron is also a man who moves quickly to limit political damage.

So if you were a betting person, it might be worth a wager that in the wake of what looks set to be a 'No' victory in the electoral reform plebicite on Thursday, Our Saviour And Liberator will not see another Prime Minister's Questions from his current seat on the front bench.