Lansley had no choice but to make a full frontal assault

In battle, confusion reigns. Amid the clash of arms, the smoke, the noise, and the cries of the wounded, the disposition of the opposing forces and even the terrain become obscured. Reason disappears; instinct takes over. Tempers rise, and a lot of blood is shed.

So it is, in a minor key, in the row over the government’s health reforms, which reached a climax with the publication last week of the Health and Social Care Bill (BMJ 2011;342:d418, doi:10.1136/bmj.d418). Seldom have so many old enemies used the cover of confusion to pay off so many old scores. Tattered banners have been raised bearing the legend “Save our NHS.” Tocsins have been rung, deaths foretold. Is this the end of civilised life as we know it?

Hardly. The NHS, as I have remarked before, is only a means of delivering healthcare, not a belief system that binds its adherents to an unchanging catechism. So, for my benefit as much as for that of BMJ readers, it is worth exploring what the bill is about and what it is not about. Is it a big change or a small one? (England’s health secretary, Andrew Lansley, has at different …