HSJ’s increasingly unfashionable, strained and conditional support for Andrew Lansley continuing as health secretary is predicated on two beliefs.

The first is that the broad thrust of reforms over the last 20 years have improved the NHS. Relatively high funding; a focus on commissioning with increased clinical input; an attempt to align financial incentives with desired actions; increasing choice through better information and a wider set of providers and more. (Of course, reality has proved less straightforward and desirable.)

The second belief is that these reforms are best driven by someone who understands the interconnected nature and underlying logic of the changes. Mr Lansley is best qualified from the available candidates, given that Stephen Dorrell is highly unlikely to return to frontbench politics or that the health portfolio will be given to a Liberal Democrat.

But there appears a real danger that Mr Lansley might actually put the reform cause back through his mishandling of the changes.

A Department of Health insider from the time of 2005’s flaky Commissioning a Patient-Led NHS reforms spoke to HSJ about the lessons from the period. First, if the answer to your problem is a reorganisation, you have probably asked the wrong question. Second, do not ask the NHS to do two things at once – especially if one is reorganisation – because it will focus on the new structures. Lastly, it does not matter if you are right if you have not convinced anyone else.

It appears Mr Lansley has taken Commissioning a Patient-Led NHS as his blueprint for national change. Failure to correct that approach could set reform back a decade – a far more toxic legacy than even the damage that the changes are wreaking in the system at present.