Despite its pause, the Conservative-led government is still missing the point about its health reforms. Although it has been driven to a halt by tanking poll ratings that has been as much about the lack of a mandate for the policy as about the policy itself.

When governments have a mandate they can get away some pretty unpopular things, because to some extent they had permission. The NHS reforms, however, as I pointed out on this site a few weeks back, didn’t have permission. That makes opposing the government a much more middle England thing to do – that’s not a hook they would want to be on quite so soon.

The pause is certainly suspiciously timed, coming as it does just before an election. It is designed, first of all, to make the Liberal Democrats appear effective and to give them some hope, maybe – though every time a former polytechnic announces it will charge nine grand a year it’s a reminder to the electorate of their central betrayal of their principles.

But the changes that are being floated are with the structural window dressing, rather than the substantive core of the bill. Giving re-assurances that there may be some level of public accountability around the notion of GP controlled commissioning is all very well, but this is the second point in the tactical retreat. GP’s, funnily enough, don’t have the complete confidence of the population largely because too many people have dubious stories about their GPs who, though the gatekeeper and contracted to the NHS, are still essentially small businessmen. I don’t mind business folk, I’m one myself. But that’s why I understand that business people are driven to a great degree, though not entirely, by their own interests – you have to be, the one’s who aren’t go broke.

Of course nobody really believes these GPs would actually buy care themselves. They would have “purchasing consortia” – i.e. they would hire people from the PCTs to do it for them.

Some level of accountability has to be a no brainer, we await the shape and size of these local quangos with interest, who said the PCTs were prefect? But that’s not the point. The core issue is allowing the private sector into the heart of the NHS. To compete in an open market with services that have to ‘do it all’, that can’t operate as an organisation that can choose the medicine, the market niche, the specialisations on which it will focus and, more importantly, what it won’t do – because it is too expensive and too difficult. The consequences for the NHS lie as much in the operation of the Labour market as anything else. In short, the private sector will pay more, hire the best people NHS hospitals, other than possibly the major teaching hospitals will struggle to compete.

There is a huge difference between the NHS using its purchasing power to deliver public health priorities by employing the resources of the private sector and allowing open season. Unless that is the “substantive reform” the Tories promise then Labour would be right to call Mr Cameron’s announcement “a smoke screen”.

And that IS the point. Mr Cameron and Mr Lansley may be prepared to cast the notion of commissioning by GP consortia to one side if by doing so they save the great prize that is opening the front door to the private sector in a way that delivers many of the problems of privatised healthcare and delivers few of the benefits.

We do need to reform the NHS. But this is STILL the wrong reform. It is, however, a battle that can be won.