Richard Marsh

Earlier this week my wife called to make a GP appointment for our daughter, who has been experiencing some worrying tummy pains.  Middle of next week she was told, earliest. ‘It’s a pity you didn’t call at 8 o’clock,’ the receptionist chided. ‘We had several slots then, but now they’ve all gone.’ Silly us for prioritising getting the children to school at that time of the morning. I expect that Jeremy Hunt would say that it is precisely this kind of thing – not a scandal, not a crisis, but just one of a million similar tiny rebuffs people experience at the hands of the NHS every week – that has led him to demand that everybody should be able to book their doctors’ appointments online by 2015.

Her Majesty’s Comptroller and Auditor General seems to have been nicking ideas from Private Eye. National Audit Office reports these days arrive with a frontispiece of 'key facts', reminiscent of the Eye’s 'number crunching' feature, plucking a handful of noteworthy numerals from the deluge of auditry that follows, and designed presumably to make the reader go 'gosh'. In the NAO’s latest report, on the awarding two years ago of a franchise to run a hospital in Cambridgeshire, one 'key fact' leaps out. '£0', it says, 'is the amount Circle will earn over the ten-year life of the franchise, unless the Trust achieves a surplus under its management'. Yes, that’s right.

Yesterday, Health Secretary Andrew Lansley reported to MPs on the state of the NHS. The state of the NHS, you'll be relieved to know, is good, or at least it is in Mr Lansley’s estimation. Budgets are in surplus, waiting lists are down and, unless you are very unlucky, you won’t have to hang around for more than four hours in A&E before they see you. One thing, however, that the Health Secretary didn’t volunteer - curiously, since it was the biggest NHS news of the day - was the reorganisation of heart care for children, and the closure of three specialist surgery centres in England.

Although it is nearly 20 years ago, I can still recall being lobbied by the representatives of a private consortium who had nascent plans to redevelop a hospital in south London using the then fabulous new idea we called the private finance initiative.  Before you jump to too many delirious conclusions, the meeting took place in my office, not in an expensive restaurant, and it was the only one I ever had with the group. I may have splashed out on a plate of civil service issue custard creams. At the time I was the special adviser to the then Secretary of State for Health, Virginia Bottomley, and the main item on her desk - and mine - was a plan daringly called 'Making London Better' which, when you got down to it, involved shutting down quite a lot of London hospitals.

If you want to know why the great Labour-NHS argument about healthcare is wrong, read today’s National Audit Office report on the provision of diabetes care in England. Diabetes is one of this country’s biggest health problems and it is getting worse. There are currently over three million people with diabetes here today, and, on some estimates, by 2020 there will be nearly four. In the last 15 years the number of people with the condition in England has more than doubled. Yet according to the NAO, the treatment they receive from the NHS is little short of shocking.

At two thirty this afternoon, the Deputy Speaker announced to the House of Commons that the Queen had granted Royal Assent to the Health and Social Care Act. It seemed fitting that the House was debating assisted suicide at the time. The agonies of watching this cursed legislation twitch and stumble its way onto the statute book were enough to make anyone with half a concern for well-ordered public policy start Googling the names of Swiss exit clinics. Albeit there would have been the risk that Number 10 had already paid for Andrew Lansley's ticket to join you there. Suddenly, though, the politics of health are very different. Mr Lansley, for all the opprobrium he has borne, has his Parliamentary mandate. He has won.

So here we are again. At least Lord Justice Leveson had the humanity to give us a couple of weeks off whining celebrities, shifty ex-journalists and declaiming newspaper editors. From the Health and Social Care Bill there is no respite. The Bill is back in the House of Lords and Liberal Democrat guerrillas are wound up for a fresh assault on the lumbering mule train as it passes through. Does anyone care any more which bit of this battered and bleeding legislation has been chosen for further victimisation in this week’s shenanigans?

Andrew Lansley should be grateful for small mercies. Rachel Sylvester's column (£) today may quote a Downing Street source to the effect that ‘Lansley should be taken out and shot’, but there is yet no sign that a hundred Conservative MPs will write to the Prime Minister to say that the Health Secretary's reforms have to stop. We've had such a letter for wind farms and for Europe, but on the NHS it's not very likely. Most Tory MPs find the NHS a difficult rallying point at the best of times. And these are the worst: they are acutely embarrassed by the car-crash that has been the Health and Social Care Bill, and dearly want the whole thing just to go away. Besides, you try finding a hundred of them who actually know what these health reforms are about.