UK health secretary Andrew Lansley was once prime minister David Cameron’s boss—a little remarked fact that may partly account for the fearlessness with which Mr Lansley felt able to spring upon cabinet colleagues his controversial plans for the NHS. When he was head of the Conservative research department in the early 1990s, Mr Lansley gave Mr Cameron and George Osborne, now chancellor, their first jobs in politics.

“That explains why he and David Cameron have a good relationship and why Andrew is trusted on health,” says Andrew Jones, formerly a Conservative policy adviser and now group medical director of Nuffield Health. Indeed Mr Lansley distinguished himself at the research department, playing a significant backroom role in the Tories’ unexpected 1992 election victory, for which he was awarded the CBE.

So if he behaves like someone with credit in the bank, it may be with justification. Mr …