It’s easy to scoff at Andrew Lansley’s hapless handling of his NHS bill.

From the day he walked into Richmond House, with his bill already written, it’s been a masterclass in how not to reform public services. He didn’t listen to his officials. He assumed the support he’d received from the health professional bodies, such as the Royal College of Nursing and the British Medical Association, would continue once he became the secretary of state.

He allowed the coalition agreement negotiators in June 2010 to thrash out a form of words around ‘no more top-down reorganisations of the NHS’ and elected primary care trust boards as a sop to the Lib Dems, in the knowledge he was going to do the opposite. Not only were PCTs not to be elected (a shame, in my view), they were abolished altogether. No part of the coalition agreement differs more drastically from the actions of ministers than the health section. It should be up for Costa prize for fiction.

After arriving at the department, and slapping his beautifully crafted bill on the table (Lansley is an ex-civil servant, don’t forget), he did nothing to build a coalition of support for it. At times it appeared that Cameron and Clegg were a little unsure about its contents. Cameron is of course privately furious that his painstaking work to detoxify the NHS for the Tories has been undone by a single minister. Now, the NHS is as toxic for the Tories as it ever was under Howard or Thatcher.

Lansley’s run-in with the protester outside Downing Street was amusing to watch. The ‘pensioner’ who appeared on the front page of many newspapers the following morning is called Jean Hautot. I thought I recognised the name. And I remembered she stood against the Labour candidates, including my wife, in the local elections in Southfields ward of Wandsworth in 2002, on a ‘save our services’ ticket. The Tories won. The point of the Lansley-Hautot bout was that it serves as a metaphor for the whole episode, in that it was entirely avoidable. The windows of Lansley’s office afford a clear view of the gates to Downing Street. There’s a perfectly good door at 70 Whitehall through which he could have passed, avoiding the demonstrators and cameras. Walk past the preserved Tudor walls of the original royal palace, through the famous ‘link door’, and you’re inside No 10. And just as the PR disaster outside Downing Street could have been avoided, so the political train wreck of the NHS reforms could have been avoided too.

The problem is not Lansley’s PR. It’s his policy. Believe me I’ve tried, but I can’t work out what problem in the provision of healthcare Lansley’s bill is designed to fix. Neither, it seems, can any of the government’s own advisers. GPs are no more equipped to administer billions of pounds of public money than, say, postmen or newsagents. GPs become GPs to cure the sick, not to spend hours a week on accountancy. The problem for the BMA is that it is the trade union that cries wolf. Virtually every reform, from the foundation of the NHS itself, has been resisted by elements of the BMA, even when they were getting more money. Years after the NHS was formed, Bevan famously said he had stuffed their mouths with gold. It pales compared to the diamonds and platinum ingots that Milburn and Reid shovelled down their throats. Now, the BMA is being dismissed by ministers, even though it represents the views of most doctors who do not want to be commissioners of all NHS services.

The point of NHS reform is to give patients more choice, to end rationing based on waiting lists, and to tackle the shameful inequalities in health and life expectancy between rich and poor. That’s what Blair’s health secretaries were charged with, and what they tried to deliver. The means was unimportant. If a private sector provider can get waiting lists for cataracts or knee surgery down to a matter of days, not years, then who cares if they’re not state employees?

The next Labour government will inherit an NHS in desperate need of reform. Advances in medical science, an ageing population, and growing consumer demand will mean that the first Labour Queen’s Speech will need a radical health reform bill. There won’t be money for generous contracts with doctors and dentists, nor for major rebuilding programmes. The emphasis must be on social care, on mental health services, on tackling waiting lists, on more choice for patients and their families, and on tackling health inequalities between rich areas and poor areas.

The NHS is too important to be allowed to be left to wither. Without reform, wither it surely will. But the reforms must be Labour reforms, in the interests of patients, not Lansley’s reforms, which now only serve his inflated ego and political survival.

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Paul Richards writes a weekly column for Progress, Paul’s week in politics

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Photo: NHSE