Every successful Government knows when to compromise and when to hold firm. Those that compromise too much on their core principles rightly die slow and unlamented deaths. And ones that are unbending on every little detail expend too much political capital to achieve their full reform package.
So the key to success is getting that balance right – and that balance is inevitably more difficult for a Coalition Government.
My absolute conviction is that right now, on the vital NHS reforms that we signalled in our manifesto, we are in danger of compromising too much.
I do not mean that we cannot compromise on detail in a way that supports and enshrines our principles – doing so is obviously correct. But I certainly do mean that those core principles of returning decision-making to the front line so as to improve patient a choice and drive up quality care must be sacrosanct.
The very notion of "red lines" - as I suggested to my fellow backbench colleagues – necessarily defines areas on which we should not compromise. But by definition, it therefore also accepts amendments on peripheral matters. However, these adjustments cannot be for political point-scoring, or in order somehow to prove political virility. Those motives make the NHS a political football, and are not worthy of the people who try to play that game.
And I invite anyone who doubts that the NHS has been used as a political football to read the memoirs of a certain Tony Blair. They detail his regret at not reforming public services, and his resentment at the deadhand of Brown in stopping reform that harked back so clearly to the changes begun under us, but was reversed for purely political reasons.
Undertaking the painful work of restoring the nation’s finances will be in vain if we leave unreformed the public services which they fund. These NHS reforms, along with our radical changes to the education system and to the welfare state, are utterly vital to the long-term financial future of our country. If we wish for world-quality public services, then they need to be reformed.
So the first thing we should stick with is our core principles on reform, but we also have to stick with, and show our support for our Health Secretary. Andrew Lansley is an excellent Health Secretary, who has deep and broad support on the backbenches. Anyone who has spoken with members of the Conservative Parliamentary Party would be in no doubt about how sincerely he is backed.
He believes in the NHS. He believes in these reforms. And now is the time for us to show that we believe in him too. No Health Secretary has an easy ride all the time – the measure of them is how they behave under pressure, and he has behaved admirably.
The red line I am most passionate about is competition on quality – and make no mistake, this is the principle that we are going to have to fight hardest for. As I have recently argued, we cannot return to the disastrous policy of the NHS as a preferred provider, whereby private and not-for-profit providers had the technology, capability and drive to deliver services at NHS costs to NHS patients desperately in need, but had the doors shut in their faces for no good reason. The rest of the developed world has accepted that competition in public services increase efficiency, innovation and patient outcomes – they are simply debating how to regulate the market. The independent regulator, Monitor, will serve to ensure that competition benefits the patient, not the provider, and that is why I am resolute that it should remain.
We do need to nail the myths. Cherry picking is solved by tariff reform. Integrated care is ensured by charities who oversee the patient pathway. Monitor prevents the emergence of a "dog-eat-dog market". Wherever we hear a voter speak of the Government"'privatising the NHS" that is not the reactionary's success, it's the reformers failure.
If we are able to unite the public and politicians around those two core values – competition on quality and choice set within the irreversible model of a taxpayer-funded NHS, free to all at the point of delivery – then we can leave an NHS for the next generation that we can be proud of.