A fatal, fateful five minutes for the NHS.

"Signs of unease over plans for the reorganisation of the health service were emerging and the PM called Andrew Lansley, the Health Secretary. Mr Lansley was away, so two special advisers were invited to Downing Street to give Mr Cameron a five-minute briefing on the reforms. The pair struggled vainly – for much longer than five minutes – to encapsulate the Lansley scheme. As the door closed behind them the PM turned to Steve Hilton, his strategy guru, and said grimly: “We’re f–––ed.”"

Sue Cameron, Daily Telegraph.

Sometimes a quote sits in your mind for a while, and niggles at you. You know there's something wrong with it, but you're not sure what. This one, from a Sue Cameron article a fortnight ago, has been niggling at me.

It's intended to show one of two things. Who-ever briefed it, was, I suspect, trying to show that their boss, the Prime Minister, was not to blame for the incompetence of his Health team. Sue Cameron, rightly, uses it as an example of a Number Ten operation not comfortable with the reins of power, sometimes holding too tight, sometimes barely in control at all.

Yet what bothers me about it is that David Cameron, the Prime Minister who said his top priority in government could be summed up in "three letters: N. H. S", wanted and needed a "five-minute" briefing on his NHS reforms.

The story is dated to "a few months" after the government was formed. This means the meeting is likely to have been held after the NHS white paper was published in July 2010, when it was briefed to the Telegraph as "the biggest revolution in the NHS for 60 years" and one that represented a strong decision by the Prime Minister, who had decided to go ahead with the reforms over the concerns of his Chancellor.

As the Telegraph reported at the time "A source said: “In the end, the Prime Minister clearly said to George Osborne that this was not one he should go to war on.” Yet Toby Helm, in this weekend's Observer says that "Officials close to David Cameron also accept that No 10 paid insufficient attention to the plans before they were launched in a white paper in 2010"

What are we to conclude from this?

There are two options. 

First, the Prime Minister paid so little attention to the reform plans for his top domestic priority that he required the special advisers in the Department of Health to explain it to him in five minutes - which they failed to do successfully – then decided to go ahead with the plans anyway. 

Second, and probably more likely given the "review" of NHS reforms Oliver Letwin was asked to perform ahead of the publication of the bill, the Prime Minister signed off the plans for the White Paper, started to hear concerns in the Autumn as the bill was being prepped, and then asked for a five minute briefing to have his own key programme of reform explained to him.

This is a truly astonishing level of disinterest.

It is not as if Cameron was dealing with a rogue Health Secretary, or a minor part of the vast Whitehall empire. He had appointed Lansley, guaranteed him the job of Health Secretary, made the NHS a key plank of his leadership, protected it from cuts.

Yet the evidence, from No 10 sources, suggests he had only the vaguest knowledge of his governing agenda in this vital area. Frankly, you don't need a five minute briefing on something you have more than a passing knowledge of.

I'd understand it if we were talking about Forestry policy, or rail infrastructure spending, or even something like local government reform. But the NHS? A Prime Minister should know what their government is planning to do there in some detail.

The fact (again in the words of the Telegraph, just prior to the Bill's publication) "the new legislation has been delayed for weeks while Oliver Letwin, the Coalition’s policy guardian, combed it for booby traps" should perhaps have given the Prime Minister pause for thought. While Letwin must have given the PM the thumbs up A-OK , as I've noted before, one of the Iron laws of Politics is Letwin's Law: Anything Oliver Letwin does in politics eventually goes totally kablooie. (Next example of this will be his stewardship of Universal Credit under the sulky gaze of Iain Duncan Smith. Watch this space).

Of course, as the excellent Paul Corrigan has been explaining for some time, there is more than enough blame to go around when it comes to the NHS reforms.

You could, for example argue cogently that they represent the first truly negative consequence of Coalition government, in which a reform which was risky and ideological, but at least had an internal logic, has in the face of internal opposition been replaced by a series of incoherencies, bundled together in a Bill.

But ultimately, as Paul powerfully explains, the decision to go ahead was the Prime Minister's. Under informed, poorly briefed, inattentive and hands-off he may have been, but again and again, he chose to go ahead.

This Bill is not, any longer, really Andrew Lansley's bill.

After that fatal five minutes, It slowly became David Cameron's bill, and the great worry is that neither the Health Secretary nor the Prime Minister any longer understand the logic behind their much mutated creature, if they ever did.

They simply feel that they are at the gates of Moscow, and they cannot retreat now. So they will get their bill.

Of course, Napoleon occupied Moscow, and precious little good it did him.