Editor's blog Wednesday 8 June 2011: The political afterlife of Andrew Lansley

Tim Montgomerie edits the Conservative Home website, and has first-class access to the top of the party. His Twitter account is, therefore, well worth a browse.

And last night, he broadcast the following spectacular tweet: "Downing St source: We should now think of Cameron as Secretary of State for Health. The PM, not Lansley, will be selling govt's NHS policies".

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It's not completely true, of course. Lansley will be left filling an empty suit in the daily mechanics of the DH and the seat at Cabinet.

But it's certainly clear that health policy is now fronted by Cameron alone (as excellent new blogs today from Professor Paul Corrighan and Mike Birtwistle of MHP Mandate explore).

It's also true enough to make things seriously interesting for both Mr Cameron and Mr Lansley.

The Cameron effect
The former has staked his personal credibility with the electorate on these reforms, with fairly slight modifications. It is far too early to see how much the public will take to That Nice Mr Cameron's Indiana Jones defence: 'trust me'. (Viewers of Raiders Of The Lost Ark will recall that after uttering those words, the hero gets smacked in the face, hard.)

But it represents reputational risk for a man whom polling shows repeatedly to be more popular than his party. Lansley may have been Cameron and Osborne's boss at Conservative Central Office; and loyalty may be the Conservative Party's secret weapon. But there are limits.

Lansley - the heir to Pinter
For Andrew Lansley, the situation is rough. Six years shadowing health in opposition led him to produce a plan in office which has had the most dramatic public pause since Harold Pinter - and then been rewritten (albeit much less than many seem to think).

Nobody is ego-less enough for that not to hurt.

He has repeatedly emphasised that he doesn't want any other Cabinet job (which frankly is just as well). He has also said that he's not a politician; he's just in this for the NHS. His performance in post has validated the first half of that line. The problem that his approach ignores is that the tax-funded NHS is intrinsically, inherently and fundamentally political.

I personally don't actually hold the view that either Lansley or Cameron have the primary intention to break up or privatise the NHS. But my sense has also been that the enormously high-risk strategy would greatly facilitate that process if it fails.

And when you are tinkering about with the NHS, it is wholesale idiocy to adopt an incautious, reorganising-the-whole-fucking-system-without-telling-people approach. Oh, and spending lots of your time demonising the people you need to make the system (new or old-school) work as "bureaucrats" (or in the PM's latest iteration, "empty bureaucrats") is witless beyond belief.

So, The Secretary Of State For The Time Being is not, I think, a bad or wicked man. His micro-level of detailed knowledge of who is the night shift porter in a community hospital in Barrow is genuinely impressive; if slightly scary.

Mr Lansley has also realised some key things about real NHS change: that clinicians must be far more explicitly and accountably involved in resource use and rationing decisions; that 'it's the variations and outcomes, stupid'; that care should centre on patients, not hospitals. All are important; none had to lead to his plan or style of approach.

Lifejackets and strike batsmen
The Prime Minister threw his Secretary Of State a lifejacket yesterday. But it's an inflatable one; not solid plastic. Which means it's temporary.

In cricketing terms, Cameron knows that Lansley is a poor batsman, so he 's taken a single at the end of the over in order to take strike at the start of the next one.

The inflection point of Mr Lansley's exit has been deferred. He has been given some extra time.