Andrew Lansley, the health secretary for England, faces isolation as support for his reform of the NHS dribbles away. Threats by the Liberal Democrat leader, Nick Clegg, to vote down the health bill in parliament and a detailed critique of the bill by the Royal College of General Practitioners have significantly worsened what was already a precarious position for Mr Lansley.

Paradoxically the Liberal Democrats’ disastrous results in local elections last week and the crushing defeat of the proposal they favoured to change the voting system have strengthened rather than weakened Mr Clegg’s hand. Already under threat from rebellious grassroots Liberal Democrats, his position will be desperate if he cannot extract concessions over the bill. David Cameron, who himself harbours doubts, will be happy to oblige, using Mr Clegg’s troubles as cover for a retreat in which Mr Lansley will be the victim.

In January Mr Clegg was giving the bill his full support, even claiming that the abolition of primary care trusts and strategic …