It's been a few weeks now since the Cabinet reshuffle at which Andrew Lansley lost his job as health secretary, to be replaced by Jeremy Hunt. The feeling inside the NHS was very much one of "out of the frying pan, into the fire" and this was pretty much confirmed a couple of days ago when Hunt lined up Christine Lineen to be one of his policy advisors.
But apart from that and a couple of hospital visits, Hunt has stayed quiet. It remains to be seen what impact he'll have on Lansley's plans for a complete top-down reorganisation of the NHS - the very thing the Coalition Agreement (and the Tories' pre-election pledges) promised would not happen.
It's worth pondering where it went wrong for Lansley. Was it that broken promise, going against the very fabric upon which the current government was built? Or was it his final throw of the dice - his plans to market the NHS abroad? Or perhaps it was his failure to communicate openly and honestly about what he was really planning to do - or maybe, on the other hand, he gave too much away.
That "marketing abroad" thing is a good example of the lack of joined up thinking on the NHS from the Tories. One thing it gets right is that the NHS is a brand, shared by lots of different organisations, not one big organisation. So it wasn't "the NHS" that Lansley suggested should be marketed abroad, but individual NHS trusts.
Now the key thing to remember here is that the NHS is, rightly or wrongly, a competitive marketplace. Just like in other businesses, NHS trusts work together in some areas and compete in others. And just like in other industries, NHS trusts will try to leverage any competitive advantage they can find to out-do their rivals. So it's vital that any new innovation applied to this marketplace is done so fairly and doesn't unfairly hand an advantage to some trusts while disadvantaging others.
This is where the NHS as a marketplace is already institutionally unfair. Because while informed healthcare commissioners will judge trusts based on their performance, many will simply opt for the big brand names. So no matter how hard other children's hospitals work, no matter how much they achieve, they'd never be able to match the Great Ormond Street brand, even if GOSH performed really really badly. This skewing of the marketplace is constantly reinforced by the likes of Lord Sugar and Piers Morgan constantly trumpeting GOSH and ignoring their hard-working competitors and other children's hospitals up and down the country who do just as good a job.
The big hospital brands are already the richest. They are not the ones that need help.
This is where Lansley's suggestion is typical of the Tories. It allows the rich to get richer and keeps the poor poor. Lansley was adamant that any money raised from the "marketing abroad" exercise would be ploughed back into the NHS. What he neglected to say very clearly was which parts of the NHS would receive that money: the answer is that the rich trusts that can afford to market themselves abroad would be allowed to keep the proceeds. The rest of the NHS would not gain a penny from the initiative.
One of the criticisms of Lansley's plan was that Labour had already announced something similar when they were in government. But the stark difference was that Andy Burnham's plan involved marketing the NHS as a whole, with the NHS as a whole reaping the benefits. Lansley's plan was simply yet another way of making the rich richer and the poor poorer. Further unbalancing the NHS marketplace in such away offers no hope at all for lower profile trusts, no matter how well they perform.
The NHS was intended to be a single, united, national health service not a brand war battlefield. I sincerely hope Jeremy Hunt catches hold of that original vision and stops the pointless fragmentation and wasteful inter-hospital rivalry that his predecessor was so keen to exacerbate.
