Since the coalition government was formed in the United Kingdom in May 2010, the secretary of state for health for England, Andrew Lansley, has dogmatically pursued a highly controversial health reform agenda in the face of widespread public and professional opposition. Lansley’s removal last week from the role, his demotion, and his replacement by Jeremy Hunt have provoked much media comment about his track record and the future of his health reforms. Lansley spent six years as shadow health secretary in opposition. During that time, he apparently gave much thought to how to achieve his vision of the NHS as a market based healthcare system in which private, not for profit, and public providers compete alongside each other, with general practitioners commissioning health services on behalf of their patients.1 However, the past two years have delivered a painful and costly demonstration of how not to do health reform.

Four main weaknesses undermined Lansley’s efforts to reform the English health service. Firstly, it was not clear what …