Shadow ministers are preparing a last-ditch attempt to delay the health bill next week, as most signs pointed to the bill reaching the statute book on 20 March, prompting a new two-year argument outside parliament on the bill's true impact on the NHS.
Ministers and officials acknowledge in private, with an almost gallows humour, the political damage caused by the bill. They think the sooner it is law and out of the limelight, the better. No more amendments or pauses will be contemplated. The hysterical predictions about its impact can then be exposed, ministers argue.
But Andy Burnham, the shadow health secretary, was refusing to give up the fight, even though the Lords had voted through some of the most controversial measures on Tuesday night with large majorities.
He admitted: "One of the frustrating things in the past fortnight is that the more friendless this bill becomes, the more determined the government seems to be to push it through.
"I hope the dynamic can still be changed, but it is getting desperately late." He is pinning his remaining hopes on three external forces.
First, a tribunal – probably this week – may rule the NHS risk assessment should be published , which is bound to lead to an appeal by the government. If so, Burnham hopes peers at the third reading next week will delay the bill for a further month until the risk assessment is published. Lord Owen, the former SDP leader who went down a storm at the NHS workers' rally tonight, is likely to try to move for such a delay next week. Labour peers, disappointed by the scale of their defeats this week, still say there is a realistic chance crossbench peers could be persuaded to delay the bill on this basis.
Second, it is likely that two further royal colleges will come out against the bill shortly, leaving an embarrassed coalition government in the awkward position of supporting a bill designed to empower professionals, but deserted by health professional bodies themselves. The Royal College of Surgeons will meet on Thursday after a demand for an extraordinary general meeting was accepted. Up until now, the RCS has refused to oppose the bill outright, preferring engagement on specific issues. The Royal College of Physicians is due to complete a survey of its 30,000 members next Thursday, and is likely to join opposition.
Burnham's third hope is that the Lib Dem activists at their Gateshead conference this weekend will stand up to pressure from their leaders and vote to drop the bill, a decision that would be a huge embarrassment for Nick Clegg.
On Friday, the party's federal conference committee will have to choose between two rival emergency amendments to put forward for debate – one opposing the bill outright and another saying the bill has been amended enough to make it worth supporting. The latter amendment, supported by Lady Williams, argues that significant changes have been made to the bill as a result of Lib Dem pressure in the Lords, including "ensuring that competition in the NHS is in the interests of patients, based on quality not price; securing the commissioning process against damaging conflicts of interest; ensuring that any profits from treating private patients in foundation trust hospitals are invested in the NHS; [and] underpinning the independence of public health".
The underlying argument is that the Lib Dems have made the NHS better protected from the private sector than it had been under Labour, an argument Burnham rejects as "the most distorting piece of spin I have ever heard. The whole point of this bill is that it takes the NHS in a new direction."
Williams has admitted frustration in the Lords that the detailed virtues and vices of the bill are now little debated as two big entrenched encampments face each other. She complained that the legitimate balanced role of competition in the NHS was being forgotten.
She told peers : "I am thoroughly fed up with reading pieces on social network sites such as Twitter, which have presented the debate in terms of how we must be in favour of marketisation. That is simply absurd and it makes me angry. It adds to what has become a silly debate, a fictional debate. I am fed up with reading about how I am actually a secret marketiser when I know when perfectly well I am not."
Indeed it must be frustrating for peers. Few will have followed the complex proceedings, and compromises, over the role of Monitor, national tariffs, and the expansion of competition.
Williams retains a special status in her party, and she must know she will have disappointed many by her judgment call – one she admits may prove to be wrong. The weekend conference will reveal whether she can take her unhappy party with her. The Guardian
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