Lansley prepares for 'rough ride' with nurses

'Things can go right 99 times and nobody says a thing. It can go wrong once and it is a front-page story' says Andrew Lansley (Susannah Ireland)

It would be fair to say that the Secretary of State for Health is probably not much looking forward to this morning. At around 11.45, in the normally genteel town of Harrogate, Andrew Lansley will face more than a thousand of his most ardent critics: the massed ranks of Britain's nurses.

The question is: why does Mr Lansley look so chipper? Gone is the slightly hunted look and grey pallor of earlier this year when his health Bill was finishing its tortuous progress through Parliament. "I see nurses all the time," he says, and muses later: "I normally expect a rough ride."

Mr Lansley's cheerfulness is largely a consequence of the strange and unpredictable shifting sands of politics. Two months ago, the conventional wisdom was that he was for the sack. But then the Budget happened, and a string of crises have changed the political landscape. Suddenly health has disappeared from the headlines and with that change comes Lansley's renewed confidence.

"The politics of it is dead simple," he says. "If we don't do these things now, by 2015 and the next election the NHS will be in crisis [because of a lack of money]. Each year the NHS has seen an increase in the number of people going to A&E departments, an increase in the number of people being referred to hospital by GPs, an increase in the number of people who arrive in hospital as an emergency admission, and an increase in people going for planned operations – all by as much as 3 or 4 per cent a year.

"This year the figures suggest that the number of planned operations have gone up, but each of the other three areas are flat or have gone down. That is because we are now treating people more effectively in the community."

And that helps reduce the cost of the NHS on the taxpayer? "Yes," he says.

But significant problems remain. The NHS has to save £20bn over the next four years and critics point out that many of the changes Mr Lansley wanted to bring about could have been done without the time-consuming and distracting legislation he was so keen on.

Mr Lansley rejects this, believing it is possible to enact his changes while making savings and improving patient care. "Actually the service is doing very well," he says, "we are in a place at the moment when we've got waiting times at exactly the same level where they were two years ago before the election. The proportion of people waiting more than a year has gone down by two-thirds."

The huge difficulty will be sustaining improvements as cuts get deeper – especially with a recalcitrant and demoralised staff. It is partly because of this that Mr Lansley is making the trip to Harrogate. His message: we are on the same side.

"Over the last year or so nurses have felt that they and the care they provide have come in for a lot of stick and I can sympathise. As a politician I know perfectly well that things can go right 99 times [out of 100] and nobody says a thing about it. It can go wrong once and it is a front-page story."

So how does he want to leave the NHS and be remembered? "I would like people to say: we now have not only an NHS that everybody has access to, but one which clearly delivers some of the best healthcare anywhere in the world."