The Health and Social Care Bill has had anything but an easy ride. A year on from its introduction, the bill -- more controversial than ever -- is returning to the House of Lords.
Yesterday saw intense speculation about the future of the bill, and of its creator, Andrew Lansley. Writing in the Times (£), Rachel Sylvester quoted an anonymous Downing Street source saying that the Health Secretary should be "taken out and shot". She also discussed rumours that the former Labour health secretary, Alan Milburn, could be given a peerage and parachuted into the cabinet.
Rather provocatively, the Times (£) has followed up today with a piece by Milburn, in which he issues a stinging criticism of the bill:
The Health and Social Care Bill is a patchwork quilt of complexity, compromise and confusion. It is incapable of giving the NHS the clarity and direction it needs. It is a roadblock to meaningful reform.
The article is an edited extract of an essay Milburn has written for Reform's The Next Ten Years, published at the beginning of next month, and as such makes no reference to the current speculation. While arch-moderniser Milburn reiterates his belief in the urgency of reform, he also states that he does not "believe that the current government can or will make these changes". Perhaps he will not benefit from a cabinet reshuffle after all.
Indeed, David Cameron is reportedly keen to squash rumours of the imminent demise of Lansley and his bill. Public and professional hostility remain: 90 per cent of respondents in a British Medical Journal poll said the reform should be scrapped, while 50,000 people (including celebrities such as Stephen Fry and Jamie Oliver) have signed a petition to drop it. But it appears that rather than back-tracking, Cameron will throw his weight behind the reforms to get them on the statute book sooner rather than later.
And this might just be possible, as Liberal Democrat peers have indicated that they will end their war on the reform, saying that the changes they secured -- the bill has had more than 1,000 amendments over the last 18 months of battle -- will safeguard the NHS and regulate competition.
So it looks like full steam ahead. But Cameron has some serious work to do if he wants to get the public on board and convince voters that, after his careful work detoxifying, this is not a return to business as usual for the Tories and the NHS.