It is somewhat unfortunate for Andrew Lansley that the legislation on which his reputation and legacy will depend is called the Health and Social Care Bill.

Up till recently, it was the health part of the equation that was causing the Health Secretary difficulty, and which led to the intriguing new constitutional development known as a ‘pause’ in the legislative process.

But now the focus is also on the social care issues. This is thanks in part to BBC Panorama’s genuinely shocking film about abuse in a centre for people with learning difficulties, and also because of the financial problems facing Southern Cross, a private sector company looking after 31,000 vulnerable people, many on behalf of local authorities.

The ideological cornerstone of the health reforms is the idea that outside providers are likely to deliver service as good as, or better than, that provided by the institutions of the State, particularly is the profit motive and the notion of performance-related pay (the current bugbear of the BMA) are thrown in.

There are no doubt plenty of good people providing good social care in the private sector. But politically, this has a bad feel to it, and will require very careful political handling. That is one department where even Mr Lansley’s colleagues would recognise he has not covered himself in glory since introducing his Bill.

Number 10 seem to be taking a close interest in both sides of the equation. They are right to, because both are beginning to emerge as problems that will require a lot more than the time, effort or intellectual rigour the Prime Minister thus far appears to have contributed.