It has taken the Conservatives an entire decade to recover from their last attempt to legislate for a reorganisation of the NHS. Now, they're proposing to unpick some of what's left of that Health and Social Care Act.
Details of a Health and Care White Paper leaked to the excellent Andy Cowper at Health Policy Insight last week revealed that ministers want to grab more control of the health service overall, as well as individual foundation trusts and matters such as water fluoridation. The Health Secretary will become significantly more powerful.
Some of this forthcoming legislation contains changes NHS England has long wanted and been expecting, such as abolishing Andrew Lansley's clinical commissioning groups and replacing them with integrated care systems. The new powers for the Health Secretary, less so.
There has been growing irritation within the government at the way in which Simon Stevens, who was partly brought in as NHS England boss because he was a political operator, has turned out to be an effective political operator – often more so than his professionally political counterparts. Stevens is expected to leave the role later this year, so this is far more about setting things up for his successor.
The Health and Social Care Act 2012 was supposed to 'take the politics out' of the NHS. But ministers have always struggled with what operational independence actually means in practice, because they are the ones who are hauled before parliament when something goes wrong.
Jeremy Hunt would have weekly meetings covering the day-to-day running of the service when he was health secretary, for instance. He knew that an issue as big as the NHS just couldn't have the politics removed from it.
As I've often argued on Coffee House, 'taking the politics out' of a policy is a silly phrase, in any case, because it dresses up removing ministerial accountability and giving it to an unelected public official as a noble, cleaner way of doing things. It can often be incredibly convenient for a minister to have a quango running things day-to-day: just look at the way Gavin Williamson dealt with Ofqual during the exams fiasco last summer.
But then again, it can be incredibly frustrating when someone as good an operator as Stevens out-operates you. The previous NHS chief executive David Nicholson described the health service as the 'biggest train set in Europe', which politicians just couldn't resist playing with. This latest configuration of the tracks suggests the Tories want to play the Fat Controller once again – though for how long they'll enjoy having politics back in the health service is another matter.