Andrew Lansley remains the Health Secretary for now. But, as this blog has long pointed out, he was a disaster waiting to happen. Before the election, he said he wouldn't reform the NHS (apart from in some secret memo that he sent to himself). His initial health reforms were incoherent, and hampered by his daft insistence that he was scrapping Labour's hugely successful floor targets, even though he wasn't quite doing so. This sent a signal to the system that they could push more people onto longer waits. Which they did in too many cases. When he was forced into making a major U-turn on GP commissioning - effectively removing the compulsory element - he pretended he had made no concessions at all. Which was pretty stupid, at a time when his coalition partners were demanding concessions. So, now David Cameron is being forced to expend huge political capital keeping a hopeless minister who doesn't do politics.
But Lansley is not the only political accident waiting to happen. Iain Duncan Smith may be a more likeable character, but he shares some Lansley traits - a lack of political skill and an enormous self-belief - and his plans have disaster written all over them. The Duncan-Smith reforms make perfect sense, of course, and are right in principle. It is right to aim for a single simpler universal credit, and it is pretty indefensible to be arguing that a £26k benefits limit (net) is too low. It would have been better politics to recognise the need for some regional differentials at the outset: call it a London weighting, perhaps. But because Duncan-Smith isn't really much of a politician - his politics, like that of Lansley, is limited to a sneering pretence that nobody else has ever executed any reforms of any worth in this area, especially the last Labour government. And because the echo chamber that is the Tory press cheers him on, he is convinced he will succeed. However, the Treasury expects Duncan-Smith to fail. George Osborne apparently makes no secret of his disdain for a project that relies on one failsafe mechanism for success: Government computer procurement.
Lansley and Duncan-Smith both profess expertise in their fields. But they lack the skill to sell or see through their grand ideas. The last few years may have given politics a bad name, but politics is vital to the successful delivery of change. A good politician exaggerates the concessions he or she has made to win over critics; a bad one pretends he has made none. Health and welfare reform were two of the coalition's big ideas. It is a mark of Cameron's poor people judgement that be put the two ministers least likely to deliver them successfully in charge. The PM is said to have an aversion to reshuffles. And Tony Blair reshuffled too many people too often. But if he wants to salvage either of these key reforms, Cameron needs to overcome his aversion. And he needs to do so pretty quickly.