A near mugging by an angry pensioner, protesting against NHS reform yesterday outside Downing Street, pretty much sums up the woes of the Conservative Health Secretary Andrew Lansley.
His confrontation with June Hautot, 75, came not long after a Downing Street adviser privately suggested the Health Secretary should be taken away and shot for messing up so badly.
While Mr Lansley’s task affects England only, with health being devolved, his increasing difficulties with reforming the NHS still affects those living in devolved areas in the way it is now destabilising the Tory/Lib Dem coalition government.
The problem that Mr Lansley faces is that, despite having had six years in the health brief in opposition to prepare for this job, both he and David Cameron promised “no more top down reorganisations of the NHS”.
But that great promoter of “top down reorganisations”, Tony Blair, when he was still prime minister, used to rail against the “forces of conservatism”, by which he did not only mean the Conservative Party, but those opposed to change because of vested interests.
Those involved in the heart of an organisation are, on the Blair view, usually the most reluctant to accept change. This means that reorganisations by necessity have to be top down. And this is particularly true of the NHS which, in the British Medical Association, has the most effective trade union in the UK. No other body could have won a massive pay rise at the same time as abandoning its commitment to provide out-of-hours GP visits to agree to meet targets which were already being met, as happened under the last Labour government.
Meanwhile, the Lib Dems are not exactly rushing forward to support the reforms. Their objection is that it brings private sector involvement and more competition into the NHS, something that, now it is in opposition, Labour has rediscovered its dislike for too. Yesterday Mr Cameron insisted that the government will stick with the reforms, despite opposition from Conservative peers. It is a policy that could yet bring the coalition edifice crashing down.
In contrast to all this, SNP Scottish health secretary Nicola Sturgeon looks like a heroine of the NHS by resolutely doing nothing to change it in Scotland.
Yet things are not always what they seem and time can change perspectives. Ms Hautot, who made the fuss outside Downing street, is not a random granny but a seasoned hard left activist who once shared a cell with Arthur Scargill.
And there are concerns that the lack of change in Scotland, perhaps driven by a need not to marginalise interest groups before an independence referendum, could see Scotland fall behind England in service provision.
Mr Lansley has almost no friends in his endeavours, either on his own side or in the wider public, but if he succeeds against increasingly stiff odds then he might yet be judged kindly if England pulls ahead from other parts of the UK that are stuck with their status quo.