Sketch: Cameron on the run over his ‘precious’ NHS

The PM's attempts to distract us from his NHS concessions were staggering. Pointing the other way and shouting "look!" would have been more effective.

By Alex Stevenson

A strange image struck me as I listened to David Cameron in full retreat on the coalition's NHS reforms – that of the view from a rocket ship as it jettisons one of its used-up lower stages on leaving the Earth's atmosphere. From black, the vast section of the spaceship falls away below. As it does so, the enormity of the distance between it and the ground is revealed. It's a hell of a long way.

There were significant, real concessions on offer today. The 18-week waiting time target will be kept; hospital doctors and nurses will be involved in commissioning, rather than just GPs; and regulator Monitor will no longer be solely focused on promoting competition. There they were, desperately jettisoned by the prime minister. Those watching the process couldn't help noticing that these concessions were small-scale, really. Given how sweeping these proposed changes are, there's a lot further to fall.

This is an unfortunate side-effect of having a six-week listening pause. It has allowed everyone to get so worked up about the planned NHS changes it has become plausible for the legislation to be abandoned completely. That's the demand of the British Medical Association (BMA), for example, whose offices I walked past on the way to Cameron's speech. Last month its chief, Hamish Meldrum, was telling me the government's proposals are so wrongheaded, so flawed practically and ideologically, that – as Nick Clegg said – it would be better to scrap the health and social care bill completely.

Today Cameron presented us with his take. Big news – he's not going to scrap the reforms completely. Instead he is backing down where he has to and muddying the waters where he can get away with it. Make no mistake: the prime minister is on all cylinders, straining to minimise the damage from the wreckage. Doing so requires all the tricks in the political playbook. Don't let them fool you. This is a government falling over itself in retreat.

Monitor's competition focus was a case in point. "This could be misinterpreted," Cameron claimed. He sounded a little aggrieved, as if it was very wrong for the entire healthcare community to conclude his focus was solely on competition. All he had done was tell the regulator to concentrate on nothing else. "Competition," he explained, "is a means to an end". It is now one of a number of solutions, not the be-all and end-all.

The PM would have you believe it was always this way. When he insisted that "we're not driven by ideology", I feared some of those present might implode on the spot in frustration. If it is not about ideology – a deep-seated conviction that injecting competition into the NHS wherever possible is a good thing – then what is it that motivates these reforms?

Cameron's deception operations were strained to the limit. Nowhere were they more extravagant than in the suggestion that the listening pause was succeeding in persuading those talking to ministers, rather than the other way round, that they should switch their position. "I think a whole load of people are changing their view," Cameron said. The purpose is to make it seem less conspicuous that the government is doing so. "I don't see the point in being too defensive about it," the PM shrugged. He has spent the last six weeks doing nothing but defending.

The reassurance tactic hasn't been abandoned, either. Cameron does this by calling the NHS "precious", like he is auditioning for a Lord of the Rings part. He is a "huge fan". He would not want to mess with its basic principles. "We will not be selling off the NHS," he promised. At least one person I saw wrinkled his nose at this. "Really?" they wrinkled. "Really?"

Labour has been rather left behind by the NHS debacle, largely because they did not commit to maintaining real-terms increases in NHS spending before the general election. Ed Miliband, holding his monthly press conference earlier, won a miniscule victory when he invited Cameron to resume cross-party talks on adult social care – and the prime minister agreed. The biggest highlight of the press conference came when he used the phrase "cak-handed" (cack? kak? qac?) to describe the mismanagement of the NHS reforms. He asked of primary care trusts: "Are they supposed to carry on in diminished form?" I suppose the Labour party asked itself the same question after the general election.

Miliband's comments on the NHS were frustratingly brief – he is not yet back in mid-season form after his honeymoon. It's his job to undermine the PM's retreat, tripping him up where possible, exposing the listening pause process for what it really is. There is a sense that even without him the NHS reform fiasco will rumble horribly on. Concessions have already been jettisoned, but the whole bill could yet be endangered.

Things which fall back to Earth, of course, tend to burn up on re-entry. By the time we're through with this process, there may not be much left of the NHS reforms at all.