A spate of last minute manoeuvring by politicians and last gasp pleas by NHS organisations took place this week as the Health and Social Care Bill enters the final stages before returning to the House of Commons for the decisive vote.
Deputy prime minister Nick Clegg was described widely as having received a 'bloody nose' by his own party when their spring conference last weekend voted against backing the Health and Social Care Bill.
The outcome does not force Mr Clegg to change his stated policy of supporting the Bill, which has adopted hundreds of amendments since it was first introduced over a year ago. Some commentators, however, saw it as damaging to his leadership and possibly the coalition.
The day before, the Lib Dem leadership had been patting itself on the back after forestalling a rebellion which could have seen the conference vote on dropping the Bill in its entirety and forcing that position through as official party policy.
In Parliament calls by Lib Dem rebels to drop the Bill were defeated in one debate; as were opponents in another debate, forced by the Labour Party after Manchester GP Dr Kailash Chand gathered 175,000 signatures in an e-petition on a government website. It was on the motion of declining to support the Bill in its 'current form'. The legislation has also survived various hurdles in the House of Lords.
This week the BMA, Royal College of Midwives, Royal College of Nursing and the Chartered Society of Physiotherapy all called for the Bill to be scrapped.
Dr Hamish Meldrum, BMA chairman, said: 'It is time for parliamentarians to put aside party politics, listen to the concerns of almost everyone working in the NHS and withdraw the Bill.'
The Bill receives its third reading in the House of Lords on Monday 19 March. That is the final chance to amend it before it returns to the Commons, probably the next day.
There could be a delay if the Lords decide to hold up the Bill until after they have had a chance to examine the controversial risk register, but this is unlikely. The information commissioner has ordered the government to make the risk register, a document drawn up by civil servants to explore all the possible negative consequences of a piece of legislation, available publicly. So far the government has refused to do so.
RCGP clarifies its call for co-operation
Royal College of GPs leader Dr Clare Gerada has written to the government clarifying her organisation's position on the Health and Social Care Bill.
She had been accused of backtracking on her long-term opposition to the legislation after offering an olive branch to the government and seeking dialogue on the reform.
She said the college has written previously to the Prime Minister, as well as to the Health Secretary Andrew Lansley and deputy prime minister Nick Clegg calling for the Bill to be withdrawn in the interests of patient care and that position is unchanged.
However, she said: 'The fact remains that, whatever happens, it will be our 34,000 GP members who live and work in England who will be expected to make things work to the benefit of our patients. Whatever happens with the Bill, the changes to the infrastructure of the NHS are happening now as PCTs [primary care trusts] are dismantled and the new commissioning arrangements are being implemented. It is right and logical that the college invites the government to work with us to ensure that the NHS is fit for purpose, stable and safe for the patients who use it, now and in the future.'
She added: 'We have repeatedly said that this Bill will have a damaging effect on patient care and will fragment the services that the NHS provides. Whatever the future of the Bill, there is an urgent need to secure the stability of the NHS in England now.'