David Cameron delivered the support for Andrew Lansley that was advertised ahead of Prime Minister’s Questions – he has “better career prospects” than Ed Miliband, the PM said. Maybe he could’ve found something slightly more supportive, given by his measurements that’s a pretty low bar. But I don’t think it was meant as anything other than a signal of support.

08 cameron nhs r 602x200 Lansley dilemma for CameronWhat David Cameron discovered today, will be reminded of next week (as he campaigns on the NHS) and in the weeks ahead is something that I’ve heard aides say for months behind the scenes: if Andrew Lansley stays in his job, David Cameron will have to be “his own health secretary.” Andrew Lansley, they say, will get on with the adminstrative stuff but he can’t do the politics. Ditching him while the Bill is still going through Parliament would be an unthinkable admission of poor judgement and look chaotic.

Ditching him immediately afterwards wouldn’t look that much better – remember, Andrew Lansley was one of the very few shadow ministers David Cameron insisted would keep their portfolio in government. It would put a giant question mark next to David Cameron’s judgement in entrusting the NHS to Andrew Lansley in the first place if he turns round and effectively admits that was a gross error by whipping it away from him.

So the No 10 aides wince and anguish, try to write speeches in English for the health secretary … but the moment when David Cameron can stop being his own health secretary is not yet nigh (or Nye, if you prefer).

And having tangled with the NHS so publicly in a grandly announced major reform bill (Andrew Lansley’s biggest mistake in George Osborne’s view and David Cameron’s) the reform programme “so large it can be seen from outer space” (as the NHS Chief Executive Sir David Nicholson described it) will pepper PMQs and political debate all the way to the General Election.