David Cameron came a bit late to the selling of tuition fees and is coming a bit late to the NHS reform debate too. And it’s not a reform that lends itself to the 20 second “elevator pitch” as he proved in a lengthy speech this morning. Tony Blair would’ve  started earlier and stronger, you can’t help thinking.

David Cameron’s main pitch today was trying to convince voters that this is not elective surgery that he is carrying out on the NHS but emergency surgery. A tricky sell when public satisfaction rates are high.

But there’s something else, related, that strikes you about the NHS reforms. The White Paper was dashed off in six weeks, remarkably short time for such a major reform, and No. 10, I’m told, didn’t make substantial changes to it.

Arguably, under Blair and Brown, No. 10 got too involved in departmental business, micro-managing. But some senior civil servants argue that it did act as a whetstone grinder. Policies were constantly subjected to test, scrutiny – often a painful process and not foolproof – but there is little to match that in David Cameron’s slimmed down No. 10 operation.