Momentum is a priceless asset in public sector reform. New governments tend to have momentum - commonly called “the honeymoon period.”

The coalition is enjoying a strong honeymoon period and the health reforms appear to be playing their part. A MORI poll suggests that GP commissioning is the policy the public have greatest awareness of.

‘The common view is that the reforms are in serious danger of being upended by the tactics adopted to implement them’

So far, so good? Unfortunately not. Only 7 per cent of MORI’s sample thought the change would improve care.

What is more, the opinion expressed anywhere but the platform at this week’s Conservative Party conference is that the reforms - appropriate and welcome in principle - are in serious danger of being upended by the tactics adopted to implement them.

Backbenchers are confused, while Number 10 and the Treasury are growing increasingly nervous. The party’s grandees, who had assumed that health secretary Andrew Lansley had defused the NHS as an issue, are now paying greater attention.

What they hear as they consult is that the reforms are running into the mud because responses to the white paper from a wide range of groups give the same lukewarm support for its principles, before moving sharply on to concerns about implementation. The background music is provided by the significant cuts that all know are on their way.

Mr Lansley persuasively argues that the NHS must answer many of the outstanding questions itself, rather than waiting for the government to fill in the blanks. Time will be needed to find the right solutions, which will differ across the country.

However, the fundamental mistake of announcing the scrapping of primary care trusts - and as a result weakening management control - before better establishing the new system, is that it created a hurdle to progress it is not certain the government can or will clear.

Read more

PCTs make slow progress with QIPP

Michael White: Rattled by reform

PCTs make slow progress with QIPP