Michael White: these are dispiriting and dark days in NHS politics

When those arch-opponents of the Health Bill at the British Medical Association announced that they were balloting their well-paid members on industrial action (not a strike, mark you) over pensions you could almost hear voters raising a sceptical eyebrow.

Working until they’re older and paying higher contributions? Yes, but almost everyone’s in that boat and the docs have done pretty well lately even without those “ghost” lists of bogus patients which the unkind tabloids love reporting. So it struck me as bad timing in the PR battle with the coalition. Aren’t these chaps meant to be taking over £60bn worth of commissioning budgets? Don’t they do money?

But then, when temperatures soar, everyone makes mistakes. Was embattled Cynthia Bower right in announcing her resignation as head of the Care Quality Commission during last week’s furore over the bill but ahead of a series of critical reviews? Not all MPs think so. Should Andrew Lansley have used the front door to Number 10 when he attended that ill-judged health summit where he was ambushed by serial protestor June Hautot?

Certainly not, but should Hautot later have boasted that she’s been opposing hospital closures for 30 years and is – although she doesn’t know it – therefore part of the problem in the battle to modernise the NHS and get full value for your taxes? No again. Should the secretary of state have been blamed for heavy-handed PCT treatment of a senior whistleblowing doctor in Cumbria? Of course not.

And so on. Should Andy Burnham insist – he keeps doing it – that Lansley’s extension of competition within the provision of NHS services is a “complete break with NHS history” and from New Labour’s decade-long move in that direction? Most observers don’t agree and most experts (including the bill’s many critics) agree that properly regulated competition and integration of social/mental care are both needed to offset the financial and demographic challenges.

No again. It is all a dispiriting mess. No wonder that after hearing two Lansley aides failing to explain the bill in plain English David Cameron is reported to have turned to Steve Hilton – the Yoda of Number 10 – and said “We’re fucked”. And that was before a top copper appearing before the Leveson phone-hacking inquiry mentioned in passing that the Sun’s (alleged) “network of corrupted officials” included (unspecified) health officials. One more worry there.

By the time this reaches you the bill compromises hammered out in the Lords may be clearer. German voters, who have lived with the choreography of coalition politics for generations, would readily understand the need for Nick Clegg to signal one thing and for his senior partner, the PM, to indicate that it’s all detail. Cameron can live with some of the proposed Lib Dem changes to prevent the import of “a US-style market in the NHS” (and save Clegg’s spring conference on 9-10 March), but not all.

Competition remains the core battleground before the bill becomes law, as everyone knows it will despite the rhetoric. But it’s fair to say the Lords debated other issues well this week, including the medical duty of candour (tricky) and the (even trickier) need for a conflict-of-financial-interests register for GP commissioners. That was proposed by Lord Phil Hunt with heavyweight support, but voted down by 259 to 186 on Monday.

For Cameron the prospect of having to sit reassuringly by the NHS patient’s bedside every time it catches a cold between now and 2015 is a bleak one. He has carelessly brought it upon himself.