The Lib Dems have voted almost unanimously to reject Torybplans to reform the NHS.
But will coalition work?
And will Lansley listen?
If not Coalition is dead.
If it does the Lib Dems have a life line (no more).
I remain unconvinced that much change was needed. The Lib Dems seem to share that view - because all the Lib Dems seem to want is a change of PCT board structure when all is said and done. And that may be enough.
But what they do know is:
â€šÃ„¢ No decision about spending of NHS funds should be made in private, which could have happened under the proposed GP consortiums.
â€šÃ„¢ NHS commissioning must be retained as a public function, rather than sub-contracted to private companies.
â€šÃ„¢ No new private providers should be allowed where there is risk of cherry-picking.
â€šÃ„¢ GP commissioning boards must construct annual plans in conjunction with new health and wellbeing boards.
â€šÃ„¢ There must be a continued separation of commissioning and provision of services to prevent conflicts of interest.
â€šÃ„¢ Half of the members of the new commissioning consortiums must be local councillors appointed as non-executive directors.
For Downing St to say:
This is not about significant changes to the policy but about reassuring people with minor changes to the language of the bill as it goes through the House
is nonsense. This is about putting democratically elected councils in charge. It's about saying GPs should be GPs. It's about saying it's impossible for the NHS to survive if Lansely has his way.
But can the Lib Dems deliver? We're watching, without much hope.