The royal colleges - representing health professionals (whether these are medics, nurses or midwives) - are not natural rebels.
Possibly mindful of their charitable status, if they disagree with government plans they prefer to do so behind closed doors, and to use the carrot of co-operation rather than the stick of confrontation.
Despite this, last week the Academy of Medical Royal Colleges were preparing to announce that, with the exception of the Royal College of Surgeons, all were opposed to the Health and Social Care Bill. The academy later pulled back from releasing the statement - apparently after college presidents received ministerial phone calls - and agreed to continue discussions with the government. Many will be disappointed at this apparent loss of nerve, but at least Mr Lansley cannot claim to have the academy’s support (can he?) That cat is out of the bag.
Until last week the government could dismiss opposition as coming primarily from the “usual suspects” - unions, hostile media and pressure groups. It could claim the avalanche of opposition from individual health professionals was rooted purely in self-interest or aversion to change. And it could tell us that the clamour from alarmed members of the public had occurred because the poor dears simply didn’t understand such a complex piece of legislation.
So now, only the surgeons are truly on-side. A profession that cynics might say stands to benefit most if the Bill becomes law without significant changes. Why? Because it’s difficult to see the aftermath not leading to longer waiting lists - and when people wait longer for surgery, if they have the money, they are more likely to go private.
Despite the plethora of clearly argued cases against the Bill that have been presented over the past 18 months - many of which have come from highly respected organisations not given to overtly political pronouncements, the government has pressed on. With virtually no credible support, how will it now justify forcing through this radical, unmandated and unpopular legislation?
An Ode to Mr Lansley (with apologies to Martin Neimöller)
First the unions opposed my Bill, but they oppose for the sake of it so I ignored them
Then the media opposed my Bill, but they make bad news out of anything so I ignored them
Then the pressure groups opposed my Bill, but they are professional agitators so I ignored them
Then health professionals opposed my Bill, but they were just worried about their pensions so I ignored them
Then the public opposed my Bill, but they weren’t intelligent enough to understand it, so I ignored them
Then the royal colleges opposed my Bill (except for the surgeons, who I heart), but it’s more important to be strong than right, so I damn well ignored them too