Opposition to the Health and Social Care Bill has created some odd paradoxes. It sets a health secretary who wants to give powers away against those who, years of protesting about ministerial interference notwithstanding, want him to retain them. And the same people who grumble that Andrew Lansley’s bill is one top-down reform too many clamour, nevertheless, for it to be amended so that his powers for yet more top-down reforms remain entrenched. As Hilaire Belloc put it, always keep ahold of nurse, for fear of finding something worse.

The argument over ministerial power and accountability has now taken centre stage, and there are distinct signs that the government is getting rattled. The committee stage of the bill in the House of Lords has already seen two clauses kicked temporarily into the long grass: clause 1, which covers the health secretary’s duties and obligations, and clause 4, which gives a generous measure of autonomy to NHS organisations by declaring that any person exercising functions or providing services in the NHS is free to do so “in the manner that it considers most appropriate.” …