The politics of reform are being played out this week. I've been watching intently as the communications battle is waged on TV and radio, in newspapers and in the House of Commons, as the government try to get their message across as to why the proposed NHS reforms are for right approach.
David Cameron has led the way - as he has led his party on this issue - with passion and real conviction. He has a personal story to add depth to his words in a way few politicians do. So why does it feel as if the message isn't getting across to the man in the dog and duck?
As is necessary when dealing with a subject as serious and iconic as the nation's public services, the prime minister made a speech of much weight and consideration. His argument was well constructed, sweeping in its content the speech even had some Kennedy-esque flourishes ("It's not that we can't afford to modernise; it's that we can't afford not to modernise"). Ultimately though he failed to communicate why these reforms will make people's lives better.
The government has a great weapon in its armoury in Andrew Lansley; if anyone can be the architect of reform for the NHS it is he. I once attended a meeting with Lansley where he met with a mixture of GPs, primary care managers, front line nurses and carers. None had his in depth knowledge of the way all their individual responsibilities were intricately inter-woven in the great bureaucracy that is the National Health Service.
This in itself causes a problem. Too often Lansley seems to forget who he is talking to in media interviews. If healthcare professionals struggle to keep up with him, how on earth will the families sat at home worrying if these reforms will ultimately lead to cuts. This isn't to say that Lansley is the wrong man to lead these reforms, just the wrong man to communicate them on Sky News at 7:45am.
The high point of this week's communications battle was an article in The Sun in the name of Kingston-Upon-Thames GP, Dr Charles Alessi, which outlined precisely what the reorganisation will mean to those most in need of NHS treatment. Politicians often get criticised for dumbing down arguments, worrying about soundbites first and policies second but if the messaging isn't right then the policy will never get through to those who matter.
This article - which I imagine was placed as part of the comms plan by Downing Street - was spot on as well as demonstrating that there is essential third party backing for the reforms. This has been another weakness in the government's communication strategy; even before David Cameron had made his speech at the Royal Society of Arts GPs and the British Medical Association were lining up to condemn the plans. Once the unions and Labour chucked in their two-pennies worth the government spokespeople were plowing a lonely furrow.
It was a major tactical error not to have lined up a significant list of notable third party advocates for these reforms and to have mobilised them in the first crucial hours. In crisis communications: speed kills. Once government spokespeople were in defensive mode, getting pulled ever further away from what their key messages should have been, discussing the nitty-gritty of NHS reorganisation the media war was as good as lost.
David Cameron himself referred to Tony Blair at least a couple of times in his keynote speech launching the reforms. In particular the assertion that Blair should have pressed ahead with public sector reform more quickly. For Blair reform was a way of helping to refresh and continue to refine the Labour Party. If he was met by a wall of dissent it actually helped, to a certain extent, with communicating the value of the reforms. It is different for Cameron. He needs professionals to support him as to look isolated will play into the hands of those criticising these reforms as based on nothing but ideology.
Labour's tactics are to try and paint the coalition as the "Tory-led government", referring to ideology and broken promises whenever possible. The aim? To get voters doubting Cameron changed the party at all and wonder what the true motivation is behind the coalition's cuts.
Getting bogged down in debates over scrapping PCTs, reorganisations, health inequalities, budgets of billions of pounds, financial autonomy, competition in public service provision doesn't tell you or I whether our services will improve.
Reforms are tiring, draining on individuals, a strain on party morale and a threat to polling numbers. Ultimately this is why Blair was timid in what he achieved compared to what he wanted to achieve. Blair won many battles on domestic policies but a combination of Gordon Brown and matters beyond these shores blunted Blair's ambition to achieve change.
If you take the time to read David Cameron's speech on why our public services must be reformed - and at pace - you will have little doubt of his motives or ambition. The reforms are designed for all the right reasons. The problem is very few will ever read that speech but many will catch a snippet of news in a free morning paper, on the radio or via Twitter.
Perhaps all of Downing Street's energy went into creating the speech without planning how to break it down in a way the majority of us - who don't understand the NHS like Andrew Lansley - could easily digest and conclude these reforms will be a good thing.