IN outlining “real changes” to controversial plans for NHS reforms, David Cameron has taken ownership of a policy which could make or break his Government.

He knows how much the NHS means to the electorate – and he knows that Health Secretary Andrew Lansley has failed to convince those voters that the health service really is safe in the hands of the coalition.

With unease growing, Mr Cameron needed to take more personal control and we welcome the fact that he has listened to the concerns of those at the sharp end of the health service.

We like governments which listen and the decision to involve hospital doctors and nurses, and not just GPs, in commissioning care, represents progress. But doubts will remain over the thorny area of competition between providers, as well as the Prime Minister’s headline pledge to increase spending on the NHS.

On the day he was making that promise, one major North-East hospital trust was announcing an emergency package of spending cuts totalling £22m.

The chief executive of the South Tees Hospitals NHS Trust, Simon Pleydell, says his trust started this financial year £6m worse off than the previous year.

Balancing the books, while leaving frontline services untouched, will be an incredibly difficult task for health service managers.

The Government insists that the £20bn being saved from NHS trusts nationwide will be ploughed back into more effective frontline services.

And it is being seen to deliver, unequivocally, on that promise that has become David Cameron’s number one challenge.