Ok, I accept, it might be me. On the cusp of losing my first flush of youthful optimism.  I might be entering a pessimistic, sceptical phase.

I could be heading towards misanthropic? Noooo! I could accept sardonic; only because there is no point in denying it. If you are feeling generous, I would prefer wry. But, I am a realist. The bright polish of my boyish hopefulness has journeyed through the sanguine and been corroded by experiences that have pushed me into being a touch, a tiny bit, a soupçon, well... cynical.

There; I've said it. In a circle of complete strangers I have joined the group, stood up and said; 'My name is Roy Lilley and I am a cynic'. A small ripple of applause might warm the cockles of my hard heart.

I'm working my way towards contemptuous, derisive and scoffing. Why? Because I have had my fingers burned. I made the catastrophic error of trusting David Cameron.

I'm old enough to be his father and feel licensed to give him a bit of a Dutch-Uncle; David, either you are a fool or a liar and I can't figure out which. Either way, you need to sort this out before the election.

David is privileged and all the rest but you can't choose where you are born or who your parents are. As a young family man he suffered the agonies of a profoundly disabled child who was not to reach manhood. An experience that would leave a fingerprint on a soul made of Teflon.

When he said there would be no more top-down reorganisation of the NHS I believed him. I thought his personal experiences would have cemented his commitment to the men and women who create and run the health services. When Andrew Lansley's madness was unveiled as the Health and Social Care Bill, I never thought for one moment Cameron would see it through. I really did believe the 'pause' was designed to find a graceful way out of an ugly cul-de-sac.

I followed Lansley around the pre-election conference circuit and heard him, time after time, talk of reducing bureaucracy, putting Doc's in the driving seat and introducing a management cost cap. He never mentioned the wholesale destruction of all the instruments of management and replacing them with a cat's cradle of unworkable bureaucracy and beadledom.

The key question is this; just who knew what and when? Did Lansley tell bare faced lies? Did he know exactly what he wanted to do? Did he share his dark secret with Cameron or did he lie to him, as well.

The Prime Minister is in a difficult position. Either he too is a liar and knew exactly what Lansley's plans involved or he is a fool, naïve and his judgement in doubt. Was he duped by the man who was once his boss?

There is a third explanation. During the frenzied negotiations, the weekend after the election, Tory Oliver Letwin, privatiser and market maniac and LibDem David Laws, who has written of his preference for a social insurance model for the NHS, were in charge of creating a coalition health policy.  The result took everyone by surprise. Lansley included.

I think herein the truth is to be found. With trade-offs, deals and the Bond Markets breathing down his neck, Cameron was powerless to stop it.  He needed a cabinet, agreement and a government by Monday morning.

So, here we are again. An election in the offing. Cameron says there will be more money for health. Of course there will, everyone knows that. It is not a policy it is a necessity.

'Health' does not feature in Cameron's 2015 list of key election themes; the deficit, jobs, tax, home ownership, education and retirement.

How are we to interpret this silence.  Is it sinister?  Should we be worried?  The NHS is facing unprecedented pressures and the PM doesn't have the NHS on his list?  Is the answer:

I'm letting Simon Stevens crack on with the 5YFV, we'll fund what the economy allows and try to distance politicians from the NHS as much as possible.

Or, we have no policy; steady as she goes and fingers crossed.

Or, I've learned my lesson from last time and sacked Lansley.

Or, I got away with it last time and you won't believe what I have up my sleeve this time.

Prime Minister you have to persuade me and 1.4 million NHS workers, we have no cause to turn into a latter day Diogenes.  

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roy.lilley@nhsmanagers.net 

Know something I don't - email me in confidence.

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