Liberal Democrat acivists have guts after all.

I didn't go to Gateshead as I have a small part (actually three small parts) in a play that was running over the weekend and I thought that would be more fun. On Saturday I was dismayed that the conference had voted, albeit by second preferences, to debate the "accept" motion on the NHS rather than the "reject" motion. Another victory for the party managers. I was delighted therefore when the managers were thwarted and the "reject" motion was carried by a significant majority.

Clearly I didn't hear the debate, and I haven't got the terms of the bill in front of me, but it does strike me that the so-called improvements obtained by the Liberal Democrats in parliament are mostly weasel words. One that springs to mind is that there shall be no privatisation that is "not in the interest of patients." Surely everything the NHS does is, or ought to be, in the interests of patients. Another is that a Trust can't increase its private operations (up to 49%, would you believe) without the permission of its board, which would be or could easily be packed with sycophants sympathetic to the profit orientated medical industries.

It will be interesting to see how the parliamentary parties get themselves out of the dilemma. Breaking up the coalition should not, in my view, be top of the agenda. It would be bad long-term policy to abandon the important gain of a fixed-term parliament, and reform of the second chamber is still on the cards, not to mention the importance of preserving human rights and civil liberties and maintaining a more realistic, even idealistic, attitude toward the EU. Thoughts of an immediate election with he NHS as the main issue and the Liberal Democrats seen as heroes are a chimera. Elections are rarely won or lost on the issue with which they began, as Edward Heath discovered in 1974.

I don't personally see further amendments to the bill as being satisfactory. They may save some of the Tory face, but the public and medical professions clearly see the main purpose of the bill as to open up the vast funds devoted to the NHS to private profit-making enterprises, who are clearly straining at the leash to get their hands on them. A better outcome would be for the bill to be abandoned and, to save the Tory face, the whole issue placed, without gloating on any side, in the hands of a Royal Commission.

Let's hope our top negotiators are clever enough to achieve this sensible outcome.

Scabies, or a Royal Commission, for the NHS?

Royal Commissions used to be governments' way of putting difficult problems on to the back burner until everybody forget about them. However, people are not going to forget about the NHS.

For the present bill to go forward in any form whatsoever defies all sane analysis. It is opposed by almost all bodies representing the health professionals. It is hugely unpopular with almost all of the public and clearly a majority, if they were unwhipped, of members in both Houses of Parliament. It has already received over 1000 amendments, and another half dozen or so currently proposed by Nick Clegg and Shirley Williams are not going to make much difference.

That a camel is a horse designed by a committee is a tired metaphor. But camels are useful and functional animals, even if they do look a bit odd. If this bill does determine the future structure of the NHS the best comparison I can think of is the ugliest creature of which I'm aware (happily from pictures rather than personal experience), the scabies bug. I hope that comparison remains a metaphor and doesn't prove literally prophetic.

There are at least two mysteries surrounding the circumstances which have brought our supposedly sophisticated and highly educated democracy to this pass. First, Andrew Lansley is alleged to have spent several years preparing his scheme(even though it was never mentioned in the election campaign: indeed any further "top down " reorganisation of the NHS was specially ruled out.) With all that money and top brains available to the Tories you'd think he would have made a better shot at it.

Secondly, how on earth did the Liberal Democrats in government come to permit the scheme to go forward at all? It is not in the coalition agreement. Surely if our leaders were unable to prevent the majority party from doing what it wanted, they could have at least said we cannot support it. To preserve the coalition, the long-overdue reform of a fixed term parliament and other Liberal Democrat policies we would not oppose it. But we will stand aside and make it clear it is your doing, not ours. Our leaders are supposed to have first-class brains too. Why don't they use them?

"Face" being so important in politics, it is difficult to see how the Tories can back down now. But somebody should be looking for a way out which will preserve as much dignity as possible. Sometimes it is a condition of the settlement of a civil action in the courts that the parties agree not to crow publicly. Elder statesmen and women at the top of the parties should get together now and, for the sake of the future health and well-being of all of us, put the future organisation of the NHS to Royal Commission. There, in the words of W S Gilbert, "quiet calm deliberation" can be given a chance to "disentangle every knot."