Are Lansley's health reforms now dead in the water?

First David Cameron announces a “pause” in the government’s plans to reform the National Health Service in order to listen further to the views of health professionals and the public.

Then the doctor’s trade union, the British Medical Association, reveals that it thinks the Health and Social Care Bill should be scrapped, and any changes achieved without legislation.

Finally, deputy premier Nick Clegg announces that the Bill is to go back before a committee of MPs for further scrutiny, setting back its likely passage through Parliament by at least six months.

The question on the lips of many Westminster watchers this weekend is: Are the government’s NHS reforms dead in the water?

Predictably, backbench Tory MPs are up in arms over Mr Clegg's intervention, claiming yesterday that he had "bounced" the government into delaying the Bill.

They made clear that whatever changes are ultimately made to the Bill, there are certain "red lines they wish to draw against Lib Dem encroachment on the original blueprint.

In an email sent to all Conservative MPs yesterday, backbencher Nick de Bois called on his colleagues to "reclaim the debate" over the NHS.

He said the "red lines" should include the requirement for all GPs to take on responsibility for primary care across England – ignoring the fact that GPs themselves oppose this provision.

The backlash against the reforms was growing long before the Lib Dems' hopes of changing the voting system went up in smoke, but it was nevertheless this that proved the tipping point.

Once the Tories decided to throw the kitchen sink at AV, it was obvious that Nick Clegg would have to be thrown some sort of bone to keep the Lib Dems in the government, and it was equally obvious that this would be it.

Politically, sacrificing a set of unpopular health reforms in exchange for keeping a voting system that kept them in power for most of the 20th century might seem like a smart move for Mr Cameron.

But the downside is that so much had been invested politically in these reforms that the now seemingly-inevitable retreat will be seen as a major blow to the Prime Minister's authority.

Even if the reforms are not dead in the water, the political career of Health Secretary Andrew Lansley surely is.

If the government ultimately decides to press ahead with the changes, Mr Lansley is likely to be replaced by someone who can more successfully sell them to the relevant stakeholders.

If on the other hand they are watered down or abandoned, his job is almost certain to go to a more emollient politician who can re-build bridges with the health professionals.

The latter scenario is surely the most likely one. Tory MPs want the new GP fundholding consortia in place by April 2013, but in the light of Mr Clegg's latest intervention, this is looking like an increasingly forlorn hope.

The danger for the government is that, if the measures do not reach the statute book this summer, the institutional upheaval will still be ongoing in the run-up to the next election, due in 2015.

Mr Cameron is nothing if not a pragmatist, and he will surely view the prospect of organisational chaos in the NHS as a risk he can do without as he prepares to face the country again.

In those circumstances, it would make more sense for Mr Lansley's proposals to go into the next Conservative manifesto rather than into a revised Health and Social Care Bill.

And who knows - if Mr Cameron can win an outright majority next time, the Tories might even be able to claim a mandate for them.

Opponents come to aid of Great Survivor

The story is often told of the new MP who remarked on what a pleasure it was to look across the Chamber into the eyes of his enemies. The old sweat next to him responded: "No laddie, they are your opponents; your enemies are behind you."

Never was this hoary old adage more true than in the case of the Justice Secretary, Kenneth Clarke.

Like Tony Blair, Denis Healey and Rab Butler before him, Mr Clarke has always been one of those politicians who are more popular outside their own parties than they are in them.

There can be absolutely no doubt that had Mr Blair been up against Mr Clarke in either of the 2001 or 2005 elections, his majorities would have been significantly smaller. But the Tory Party might also have split in two.

As we have seen this week, Mr Clarke continues to divide opinion. Many on his own side – not to mention the right-wing tabloid press – would not have been at all displeased to see him lose his job over his comments on rape.

By contrast, it was instructive to see the conscience of liberal Britain,
Shami Chakrabarti, passing up the opportunity to twist the knife in Mr Clarke when they appeared alongside eachother on the BBC's Question Time on Thursday.

But it was not Shami who ultimately saved him, but a much more obvious 'opponent' - Labour leader Ed Miliband.

The moment Mr Miliband urged David Cameron to sack Mr Clarke over the Commons Despatch Box on Wednesday, it became virtually for the Prime Minister to do so.

My initial reading of this was that it was a smart piece of politics by the often under-rated Mr Miliband.

Keeping Mr Clarke in the government is, after all, in Labour's interests - firstly because, because he exacerbates the divisions between Mr Cameron and his backbenchers, and secondly because the policy agenda he is pursuing is not so very different from Labour's own.

Others might argue that this is way too Machiavellian for the young opposition leader, and that Mr Miliband was simply showing his inexperience.

Either way, the man who has become the great survivor of British politics lives to fight another day.

There is much less confidence this weekend in the future of Mr Clarke's Lib Dem Cabinet colleague, Chris Huhne.

Essex police are now formally investigating claims that he asked someone close to him to take some speeding penalty points he allegedly incurred in 2003 before he became an MP.

Mr Huhne has described the claims as 'inaccurate' but his denials seem to be cutting little ice with some colleagues.

One Lib Dem insider was quoted as saying on Thursday: "The conventional wisdom is that Huhne will end up having to go. He is being highly reckless in taking it to the wire like this. Chris clearly doesn't think they will find the evidence. He wants to brazen it out. He is brazen. That's what he does."

The departure of Mr Huhne would doubtless have a further destabilising impact on the Coalition, already under strain as a result of the AV referendum debacle.

Under the terms of the Coalition agreement, he would have to be replaced by another Lib Dem, with Ed Davey, Jeremy Browne and Norman Lamb among the potential candidates

Meanwhile more able Tories in the ministerial middle-ranks would once again be forced to wait their turn, as was the case when David Laws was defenestrated after just 17 days in office.

Maybe that is one of the reasons some of them were so keen to see the back of Mr Clarke.

The gamble that paid off

And so the problems continue to pile up for Nick Clegg and the Liberal Democrats.

First it was the local elections and the loss of 700 council seats, then the overwhelming referendum 'no' vote to electoral reform, now the finding of 'serious breaches of the rules' in relation to rising star David Laws' expense claims.

And it's not over yet. There are serious question marks over the future of another of the party's leading lights, Energy Secretary Chris Huhne, following claims by his ex-wife that he asked someone else to take some penalty points for a speeding offence.

The allegations have been denied, but with further revelations expected in tomorrow's Sunday papers, some Westminster observers are rating Mr Huhne's survival chances as "less than 10pc."

Is this what happens when a party that has been out of power for the best part of a century finds itself struggling to adapt to its new responsibilities, or is it simply a run of bad luck?

Either way, it was hardly surprising that Mr Clegg should have sought to reassert his party's influence in government this week, with the government's NHS reforms likely to be the new battleground between the Coalition partners.

Mr Clegg at least has public opinion on his side as far as that one is concerned , but the harsh reality is that he dare not push the Tories too far.

If he gets too big for his boots, Prime Minister David Cameron can simply threaten him with a general election which would in all likelihood delivery a Conservative majority and a Lib Dem wipeout.

For all the initial focus on the council election carnage, it is the AV referendum result that will hit the Lib Dems hardest, setting back for at least a decade the cause of electoral reform that is closest to the hearts.

With the benefit of hindsight, the whole thing now looks like a car crash waiting to happen.

As one pundit put it: "Here is a referendum recipe for disaster. Choose an issue that no one cares about, get the most unpopular man in Britain to champion it, and hold it on a day when everyone will use it to kick the most unpopular man in Britain."

Yet it's too simplistic to blame the failure of AV entirely on Mr Clegg, and in any case the outlook at the start of the campaign looked very different, with the 'yes' camp seemingly comfortably in the lead.

In this and other respects, the referendum reminded me of the one that took place in the autumn of 2004 on whether the North-East should have an elected assembly.

On that occasion, too, the 'yes' camp seemed to have a fair wind to start with, but lost the initiative once people started to take a closer look at exactly what was on offer.

Just as the people of the North-East might have supported a less lily-livered version of regional government than the one actually put before them, so the UK public might have supported a genuine form of proportional representation given the opportunity.

Instead, they were offered what appeared to many as a non-choice between the status quo and the 'miserable little compromise' – Nick Clegg's words -that was AV.

In the days following the general election last May, there was a perception that Nick Clegg had emerged as the big winner of a contest that seemed initially to have produced only losers.

If I'm honest, I may have bought into some of that myself, but the result of the AV referendum forces us to revise that view of history.

The truth is that Mr Cameron's great gamble of offering the Lib Dems a referendum on the voting system in return for handing him the keys to Number 10 Downing Street has handsomely paid off.

Twelve months on, the Conservative leader has finally proved himself the real election victor.