The coalition is prescribing bad policy and worse politics Good policy can make for bad politics. Useful reforms often invite short-term unpopularity. Sometimes the dynamics are the other way round. Bad policy courts instant popular acclaim. The last Labour government added countless ill-judged laws to the statute book to show it was "tough" on crime. David Cameron and Nick Clegg have pulled off a rarer feat. The coalition government's National Health Service reforms unite bad policy with worse politics. They foreshadow a costly bureaucratic upheaval and the fragmentation of health provision. They also promise to bury Mr Cameron's political ambition to prove the Tories can be trusted with the NHS. Philip Stephens During the next few weeks the legislation will suffer a mauling in the House of Lords. Andrew Lansley has been obliged to submit more than 100 amendments to his own bill. Many more changes will be voted through against the health secretary's wishes. Mr Cameron, though, is battening down the hatches. Downing Street's calculation is that once the bill becomes law - albeit in emasculated form - the fuss will die down. The prime minister is making a mistake. The real problems will start with implementation. The NHS needs modernising. A bigger say for clinicians, local accountability and more choice are among the things that would make it more responsive to patients. Britain should be spending more on primary care and less on hospital beds. It needs fewer general hospitals and more centres of specialist excellence. Health and social provision require seamless integration. There is a place for competition. Some of these elements are found in Mr Lansley's blueprint. They are buried, though, in the organisational upheaval. Mr Cameron says he favours evolution. David Nicholson, the NHS chief, retorts that the changes are so large they can be seen from outer space. They will cost many billions to implement. Among Whitehall officials there are fears of "meltdown" as the shake-up collides with a ferocious squeeze on the NHS budget. The Treasury worries it will have to bail out failing hospitals. Mr Lansley has so far refused to publish his own department's assessment of the risks. The mood in cabinet is no better. Last year Mr Clegg insisted on big changes to the legislation. Now the Liberal Democrats want to wash their hands of it - these are "Tory reforms." Conservative colleagues are scarcely less flattering about the health secretary's performance. All this was predictable. When Mr Lansley first unveiled his plan he failed to address a basic question: what was the problem this bureaucratic convulsion was designed to solve? The question still remains unanswered. The health secretary admits he could have achieved 90 per cent of his objectives without any legislation. Mr Lansley said he wanted to put NHS money in the hands of clinicians, notably general practitioners. Since then, almost all of the medical colleges have united in opposition to the bill. In spite of being offered £60bn of public funds, GPs have voted against the reforms. Mr Lansley has changed tack. The clinicians now represent "vested interests" seeking to derail reform. Patients are still wondering if they will ever get a look in. Promises that the changes would free up resources for so-called front-line care have given way to plausible predictions that they will add new layers of bureaucracy. In its much amended state, the health bill now contrives to be both for and against competition. The Tory-led Commons health committee has added its voice to the opposition. Downing Street aides say that Mr Cameron has no ideological commitment to the legislation. Rather, he judges that the political cost of abandoning it would be greater than that from pressing on. Mr Lansley, it is said, will be pushed out once the bill has become law. Earlier policy U-turns have led Mr Cameron's critics on the Tory right to draw a parallel with Edward Heath. You can see why the prime minister would find such a comparison uncomfortable. Mr Clegg agrees it is "too late" to turn back. He too is wrong. Margaret Thatcher said much the same when colleagues urged her to abandon the poll tax. Calamity ensued. There is still time - just - for Mr Cameron's government to change course. To do so would be embarrassing, but it would also combine good policy with good politics.