FAST FORWARD

THERE were signs yesterday that David Cameron is losing his cool. A slip-up on BBC Radio 4's Today programme -- referring to the NHS as “second rate” when he probably meant “second best” -- was not a good start to the day but his call later for critics of the coalition's NHS reforms to “grow up” seemed offensive to those representing 1.3 million staff who had signed a joint letter to The Times yesterday describing the Health and Social Care Bill as “a potential disaster”.

The signatories included the chairman of the British Medical Association, the chief executives of the Royal College of Nursing and of the Royal College of Midwives and leaders of the two trade unions most involved with the NHS, Unison and Unite. Mr Cameron continues to argue the need to push ahead quickly with reforms and yesterday even called in aid passages in Tony Blair's autobiography which express his regret at not moving more quickly in his first term of office. But surely the views of those who work at the NHS's coalface are worthy of a reasoned response from the prime minister beyond the need to get a move on. In fact the scale and pace of change are specifically mentioned in the letter already referred to -- “The sheer scale of the ambitious and costly reform, and the pace of change...is extremely risky”.