Wheels come off government's NHS 'listening exercise' barely a week in

The passage of the Health and Social Care Bill is now looking close to disastrous. With opposition to the Bill rife amongst professionals from across the NHS, even normally sympathetic papers are questioning the way the reforms have been handled:

• The Telegraph has described the exercise so far as a 'fiasco', arguing that the suggested reforms were "not part of the Coalition Agreement, and it is fair to say that few ministers anticipated such complex changes to the health service at a time when the Government is committed to so many other public service reforms".
• The Mail, whilst supporting the principle of the reforms, declared that "countless Britons believe the Health Secretary is rushing his pet project through with far too little warning or consultation... During the election, the Tories gave almost no inkling of the revolution they had in mind for the NHS. Since then, Mr Lansley has appeared determined to brush aside all objections – as if he is afraid of proper scrutiny".

Cameron no doubt thought the 'listening exercise' launched earlier this week may alleviate some of these problems. But there have subsequently been a number of worrying signs that the Government intends not to listen, but rather to tinker with existing proposals, presumably because Cameron and Lansley believe the problem is one of presentation rather than substance. Hence the surfacing of a confidential memo drawing red lines around the core parts of the reforms and signs that Lansley will be selective with regards to who he speaks to during this so-called consultation.

The Government has a big problem here. Firstly, this attempt to delay and re-present the policy won't persuade the countless numbers of people opposed to the Bill.

Secondly, the rank and file of the Liberal Democrats are clearly not going to let the reforms go through without substantial changes - illustrated by the petition by the left-leaning Social Liberal Forum that would radically alter the core of the reforms. This petition proposes that the Bill should:

a) ensure the Health Secretary has a duty to provide a fully comprehensive and free health service, with no gaps and no new charges;
b) provide more local democratic accountability for the health service;
c) curb the market obsession of the proposed reforms to prevent quality being relegated behind price and prevent the cherry-picking of profitable services by the private sector undermining and fragmenting existing provision;
d) slow down the pace of change so that the NHS, facing its toughest settlement for decades, does not implode from the stress of another massive reorganisation.

The significance of the choices that the Government makes cannot be underestimated politically - and are certainly crucial for patients. Nick Clegg is not in a position to let the reforms sail through with only minor amendments, despite the fact that he and his fellow Lib Dem MPs were minded to let this happen prior to their party conference.

Lansley, meanwhile, is increasingly looking like he is on borrowed time.