Andrew Lansley left isolated as NHS backlash wrongfoots ministers

Health secretary discomfited as government experiences collective wobble over plans to hand budget to consortiums

Andrew Lansley cut a lonely figure in the House of Commons as he announced that the government would use a "natural break" in the health and social care bill to review his NHS reforms.

Not a single voting member of the cabinet, apart from ministers involved in other business, lent their support to the health secretary by sitting alongside him on the frontbench.

The majority of questions from Conservative backbenchers were of the patsy variety drawn up by the unusually large number of government whips who sat ostentatiously on the frontbench to monitor their handiwork.

The scenes showed that Lansley is caught in a highly uncomfortable position as the government experiences a collective wobble over his plans to hand 60% of the NHS's �103bn budget to new GP-led consortiums by 2013.

The three most senior members of the government have concerns, which are all slightly different. David Cameron accepts Lansley's argument that the NHS must change to cope with an ageing population and its tightest spending settlement in a generation. But the prime minister believes that Lansley has failed to explain why it is necessary to embark on such radical reforms now. Cameron also fears that his own efforts to assure voters that the NHS is safe in the hands of the Tories is jeopardised by what he agrees are unfair perceptions about the reforms. Nick Clegg, whose party voted against the reforms at its recent spring conference, fears the government has left itself vulnerable to accusations that it is embarking on a backdoor privatisation of the NHS.

The deputy prime minister struggles to explain to the Liberal Democrats party how the reforms sit with the pledge in the coalition agreement to "stop the top-down reorganisations of the NHS".

George Osborne is alarmed that his success, as the Tories' general election campaign director, in neutralising the NHS in the runup to last year's election appears to have unravelled. The chancellor supports the reforms but is so concerned about the backlash that he has inspired briefings in the last 10 days that have suggested the government will slow the pace of change.

To compound Lansley's woes, his political mentor turned on his yesterday. Norman Tebbit, who gave him his first break as his civil service private secretary in the 1980s, used an article in the Daily Mirror to question his reforms.

Lansley is confident that the prime minister is supportive of the broad thrust of his reforms.

But in a meeting with Cameron Lansley agreed that he would have to offer more assurances to voters on the transparency and accountability of the new GP-led consortiums. He would also have to make clearer that the government wants to introduce competition and involve the private sector to be, as he said, "a means to improve services for patients, not ends in themselves".

There is irritation among some Lansley supporters at the briefings from No 11, though it is accepted that this is necessary to calm the Liberal Democrats.

Lansley likes to point out that his central plan ? to abolish primary care trusts in favour of GP-led consortiums ? is a merging of pledges in the Tory and Lib Dem manifestos. The Tory manifesto said it would strengthen the power of GPs by "putting them in charge of commissioning local health services". The Lib Dem manifesto said it would create Local Health Boards which would "take over the role of Primary Care Trust boards". Cameron largely left Lansley alone before and after the election. But Downing Street started to become nervous in the autumn as the British Medical Association, NHS Confederation and the King's Fund expressed concerns about the reforms.

Oliver Letwin, the cabinet's policy guru, was dispatched to the health department to ask searching questions.

Letwin endorsed Lansley's reforms which explained why the prime minister hailed his plans in a speech on 17 January as a key part of the government's public service reforms.

Cameron described the status quo in the NHS as indefensible and the Lansley-dictated direction of travel as the only route map to progress.

But in the last few weeks, in the wake of the vote at the Lib Dem conference in Sheffield and poll figures showing growing alarm at the reforms, Downing Street has become worried.

"Sheffield, and the amendments to the health and social care bill the Liberals were going to put down as a result of the vote there, was the turning point on everything," said one Whitehall insider.

Cameron and Clegg will join Lansley later this week as he outlines the amendments that will be made to his bill when it reaches the House of Lords.

But Tories are nervous.

One senior MP said: "The NHS is like a house that was jerry-built 60 years.

"It is a bit dilapidated and it needs a new roof so you have to reform. But the house is much admired - and so you proceed with care."

Denis Campbell

Nicholas Watt

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