I haven’t read The Times, so I am only going on an edited version of Rachel Sylvester’s column today, as summed up by Labour’s media monitoring department.

At the risk of offending Rupert’s paywall principles, I would like to print in full what the media monitors took out of it.

‘Is Lansley the exception to the no-sacking policy?’ (Ti op-ed) – Sylvester thinks it is extraordinary that Lansley is still in position as Health Secretary having so monumentally mishandled the Govt’s NHS reforms. He has failed spectacularly to persuade either the professionals or the public of the purpose of this legislation. What was intended as a symbol of modernity has become an emblem of obstinacy that will do little to improve patient care. There is deep frustration in No 10 about the Health Secretary’s handling of the “pause” in the passage of the Bill. Strategists have watched in dismay as, far from attempting to win over his critics, the Health Secretary has used the time to further annoy NHS staff and alienate voters. One insider: ‘We’re back to square one. Andrew Lansley is just a disaster’. Sylvester says he seems emotionally incapable of showing any understanding of other pple’s concerns and intellectually unwilling to consider alternative ideas. A Downing St source: ‘Andrew Lansley should be taken out and shot. He’s messed up both the communication and the substance of the policy’. Both Cameron and Osborne are remarkably loyal to Lansley, but many snr figures, Lib Dem and Tory, now admit privately that it was a mistake to introduce a flagship Bill on health when most of the key changes could have been implemented without primary legislation. Indeed, Clegg considered calling publicly for the whole thing to be abandoned — then decided, for the sake of coalition unity, to back substantial amendments instead. One strategist: ‘Health reform shld have been carried out by stealth’. The contrast is drawn with Gove’s education reforms, which have been presented successfully as the fulfilment of Blair’s schools policy rather than a complete break with the past. There is an idea circulating in No 10 that Alan Milburn shld be offered a seat in the Lords and his old job of Health Secretary. With a guaranteed free hand to change the policy, he would be asked to complete for the coalition the reforms he began under Mr Blair. By creating in effect a govt of national unity, Sylvester reckons this would neutralise the issue of the NHS. In policy terms, it would achieve many of the aims of the Bill without the controversy (Ti).

Wow! Let’s just re-run some of that. First, it is a columnist on a paper broadly favourable to the thrust of the Cameron government. Second, she has clearly come across a lot of opposition inside the government, and not just from Lib Dems. But when people are talking of taking out ministers and shooting them, that is quite something. As for the Alan Milburn as a minister in the Lords, I have two words on that – Alan, don’t (not that I think it is a runner.)

When David Cameron announced ‘the pause’, one of the more bizarre moments in our constitutional history, I assumed he would then make sure Number 10 got a grip of the Bill, and of Mr Lansley. But what was already a dog’s dinner is now something that even a dog would not touch. They are ending up with the worst of all worlds, with some of the measures effectively already being implemented, and costing plenty, and with doctors angry and confused.

I met one such at the football on Sunday, a Reading GP who said they just could not understand what they were meant to be doing now. I met another yesterday when I went to get more drugs for this bloody chest infection that won’t go away, and was met with another exasperated doctor saying they just don’t understand why, when everyone can see the car crash coming, Cameron, Osborne and Lansley just plough on so that the pile-up gets bigger and bigger.

My football GP said the only people supporting the Bill were those who saw the chance to expand their private practices. But now even Lansley’s medical profession backers are deserting him. Back to Labour’s media monitors if I may.

‘Backers of NHS shake-up turn against Lansley’s plans’ (Guard p17) – Two prominent backers of the coalition’s NHS shake-up have joined the growing chorus of critics by claiming that GPs will be ‘suffocated rather than liberated’ by the planned changes, rpts Campbell. (no relation) Dr Charles Alessi and Dr Michael Dixon are leading lights in the NHS Alliance and the National Association of Primary Care, two key pro-reform organisations. But they now fear that the new consortiums of local doctors will not have the freedom that the health secretary has repeatedly pledged. They are worried that the GP-led clinical commissioning groups (CCGs), which will replace PCTs, will find themselves unexpectedly under the control of another organisation, the NHA National Commissioning Board (NCB). In July the NHS chief executive, Sir David Nicholson, said ‘CCGs will be the engine of the new system’ and that the reformed NHS ‘gives pride of place to clinical leaders’. But the reality is that primary care doctors and clinical commissioners will not have the promised ability to make key decns because the current bureaucracy is simply being replaced by another that is growing up around the NCB, the pair claim. The DoH’s latest document about the design of the new board involves ‘layers of bureaucracy and management, with complex guidelines. The old “footprint” [of the PCTs and SHAs], ie 50 local offices, remains there, plus four sector outposts, all using a single operating model,’ the two organisations said in a joint statement. The fact that many of the staff of the new NCB will simply be staff who have joined from PCTs and SHAs ‘adds to clinical commissioners’ concerns and perceptions that they will be suffocated, instead of liberated, which in our view is fundamental to the success of clinically-led commissioning’. Burnham: ‘Things are going from bad to worse for Lansley. In the last fortnight there has been a deepening crisis of professional confidence in the government’s health bill, but until now the health secretary could rely on the support of the NHS Alliance and the National Association of Primary Care. Yet the bill’s biggest cheerleaders are now lambasting the increasing layers of bureaucracy. Even the health bill’s greatest supporters are now concerned that Lansley’s plans are so complex and full of worrying uncertainties that they risk thwarting the principle of true clinician-led commissioning’

Will this make any difference? I think it will. If Rachel Sylvester’s briefing came from deep within Cameronland, then the key complaint is the one questionining Lansley’s emotional intelligence. Cameron has more of it, and he will be looking for a way out. If not, he is daft.

But as Lansley is set up as the fall-guy, never forget this … it was Cameron who said there would be no top-down reorganisation of the NHS; and Cameron who said there would be no cuts. The cuts are already happening. The surgery I visited yesterday has lost its alcohol support and advice service. The mental health units in my area have been halved. Waiting times around the country are rising. Nurse numbers are falling. On every day in many ways, Cameron’s promise is being broken. The NHS got better under Labour. Fact. It is getting worse under the Tories. Fact.

As for ‘no top-down reorganisation’ this is as big a top-down reorganisation as it gets. If this Bill goes through, the NHS is no longer the NHS as we know it. That is a move Cameron will regret. It could yet be the end of him.

‘The great NHS sham’ (Mirror p6) – Lyons says Cameron’s vow to reconsider his health reforms was last night exposed as another empty Tory pledge, by his former adviser James O’Shaughnessy. The PM claimed the Govt had ‘listened and learned’ after opposition to the plans forced him to put them on hold while NHS staff and patients were asked for their views. But as opposition to the reforms gathered pace, Mr O’Shaughnessy admitted in a BBC radio iv the public meetings last year were a sham – just a ‘tactic’ to get them through, adding: ‘Actually, if you look at where we got to on the Health Bill, the fundaments of what we were trying to do are still there’. Burnham: ‘This is proof from one of the PM’s closest advisers that their listening exercise last year was nothing more than a PR con. When it comes to the NHS Cameron is all soundbites and no substance. The Tory-led Govt has got it’s priorities seriously wrong. The PM has taken a successful and confident NHS and turned it into an organisation that’s demoralised, destabilised and fearful of the future. The time has come for the Govt to halt its destabilising NHS reorganisation for good and focus on patient care’. Mr O’Shaughnessy: ‘We had to adopt dffrnt tactics in order to get the same principles across’ But the PM’s spokes insisted the former adviser was wrong to claim the listening exercise was a sham: ‘It was about pausing, listening, reflecting and improving the reforms. The shape of our plans, the detail of how we’re going to make all this work, that really has changed, as a result of this consultation’ (Mirror).