Two generalisations can be made about the NHS. All governments seem to think that organisational restructuring is the answer to its problems. And at the first whiff of the word 'reform' the medical profession is up in arms.
Andrew Lansley has come up with a technocratic reform of the NHS which is so complex that it is said that you can see it from outer space. Of course, the slogan 'Defend the Primary Care Trusts' is unlikely to get many people excited. But concerns that local hospitals might be made unviable by transferring business to the private sector is a more potent fear.
The underlying problems that the NHS faces are an ageing population; ever more costly medical technology and treatments; and an increase in the numbers of chronically ill. The Government is expanding NHS spending in real terms but at a much slower rate than before. This will make it difficult for the NHS to keep up with these challenges.
It is unlikely that the Lansley reform will fix these fundamental problems and there will be substantial transition costs. David Cameron is clearly concerned and he has reason to be.