There has been a touch of the ‘I had that David Cameron in the back of my cab’ to the Prime Minister this week.

Street parties for the Royal Wedding … all them Labour councils (allegedly) stopping people having fun, elf’n’safety blahdiblah … then he takes on the issue of the lack of black students at his alma mater, Bullingon College, Oxford … ‘ok, I got my facts all wrong, but you know what I’m saying’ was the post-rant defence … and now immigration, where he is in the unfortunate position of the BNP claiming he has lifted whole sections of their manifesto.

The similarities between cabbies and Prime Ministers include the fact that they are expected to have opinions on everything from Fernando Torres to Colonel Gaddafi (both under pressure at the moment). The difference is that the Prime Minister can devise policies to address the problems and talking points that consume so many words in taxis (he didn’t go for a cap on footballers’ pay when we took the Dream School kids to meet him by the way, so Torres’ money is secure even if his form is not).

It is hard to discern what the policy proposals are in Cameron’s immigration speech, and that does lead one to the view that this is all a bit of pre May 5 dog whistle politics, playing back to the public what they have said in focus groups, rather than taking a difficult policy area and really thinking it through.

… Which brings me to health. I had an interesting ringside seat to the Royal College of Nursing’s battle with health secretary Andrew Lansley yesterday. I was there to talk about mental health, and the Time to Change campaign, but was asked about how I thought they should handle the government’s NHS reforms.

It is inevitable a lot of the focus will be on Lansley, but I warned them not to personalise it too much. Cameron and Nick Clegg are every bit as signed up to these plans, and there is a danger Lansley becomes the fall guy but (post reshuffle) the basic thrust for the NHS will be the same – smaller state, bigger free market role in the NHS.

Sincere thanks to those of you who sent in examples of frontline cuts already happening. I used plenty of them in my speech, which I believe you can see on the RCN website. I also used the brilliant description by Mark Brown, editor of One in Four, on why the frontline in mental health services is a different, and more complicated concept that it is for other aspects of health care.

I also pointed out that it is important not just to allow the debate to be dominated by the reforms. Because cuts are happening to the frontline now. They promised no cuts, and no top down reorganisation. They are now embarked on a programme of both.

On the reforms, I quoted nurse Karen Chown … ‘the NHS is not failing by any objective standards. We have a lower neonatal death rate than the USA and our life expectancy is longer. It is also – contrary to misinformation by the Tories – one of the most cost-effective health care models in the world.’

And I concluded with this … ‘You have Mr Lansley visiting some of you later today. He is on his pause tour. He is listening. Well I hope he listens to those people (who responded to Monday’s blog).

I hope he listens to people surveyed recently who gave the NHS the highest satisfaction ratings in its history.

He should listen to the voters at the last election who denied his party a majority precisely because they were worried about what they would do for the NHS. It was barely an issue. It barely figured in the TV debates. Why? Because people were largely happy with the service you gave.

So now along they come – no mandate, not in the Tory manifesto, not in the Lib Dem manifesto, not in the coalition agreement – with the biggest shake up since the creation of the NHS.

I know a bit about politics. I know a bit about strategy and tactics. Understand that the pause is a tactic. The strategy is still the same – to drive through the cuts and to drive through the reforms even though they promised they wouldn’t do the cuts and even though they promised there would be no top down reorganisation.

The Tories are using the political cover of a coalition government and the economic cover of the fall-out from the global crash to do things they always wanted to, and that includes shrinking the state and that includes in relation to the NHS. And he hasn’t got the bottle to face all of you because he knows that you know exactly what’s going on.

Again it is mental health I worry about … I have yet to meet one GP who wants to take on MH services in the way set out in the reform plans, or who thinks they can run those services adequately with all the other pressures on them.

David Cameron constantly espouses the virtues of community and social wellbeing in his ‘Big Society’. Yet at the same time as attempting to sell some idea of a ‘political utopia’ they are seeking to starve the very sector that is best placed in helping them achieve their goal. It is simply not good enough to suggest that any shortfall in assistance can be met through the voluntary sector alone, because as we have heard, they are facing cuts and financial pressures too.

Let me state the obvious – a decline in the nation’s mental health budget will lead to a decline in the nation’s mental health. At a time of austerity and savage cuts the state of the nation’s mental health and general wellbeing will be essential components in overcoming the challenges our country faces in the years to come.

So what can you do? Well first of all, understand that though this is a government that wants to change the world, the prime minister is not averse to changing his mind when the political heat is on … forestry, school sports, housing benefit, school milk, Bookstart, knife crime, and of course now the Lansley pause. Margaret Thatcher may not have been one for turning. But David Cameron is. They respond to pressure, they turn when the heat is on … so let them feel the heat. Let them know what you think. Let them know that you’re telling your patients what you think, because people will believe you more than the media or the politicians. Above all please, stand up for the protection of mental health services. Persuade them that they are cutting off their nose to spite their face… that cuts today will mean not just more human suffering tomorrow, but more money needed to deal with the health, social, the criminal justice consequences.

They say the frontline is protected. You know the frontline has already been cut. And we all know the frontline faces further cuts in the future. You know that if the cuts go through and the reforms go through we no longer have an NHS as we know it and as we have built it up over the years. So fight the good fight, keep on caring, keep on nursing, keep on in the knowledge you are popular, respected and cherished by the British people whatever plans the government may have, and you have more support than it might feel like when the government are whacking you about the head.’