As a government, you know you are really in deep trouble when your invitation list for a "summit meeting" is shorter than the list of organisations excluded because they disagree with you, and the task is to find a room small enough to hold a meeting.
That was the stark reality for David Cameron, whose attempt to rally a handful of sympathisers in the Downing Street bunker to discuss "implementing" the Health and Social Care Bill went horribly sour.
Just 15 people turned up to the meeting - a handful of grasping GP commissioners, the ever eager privatiser Stephen Bubb of the Association of Chief Executives of Voluntary Organisations, a token patients' representative and a sprinkling of Establishment figures from royal colleges that have not - yet - consulted their members or declared opposition to the Bill.
Notably absent were any Lib Dems, with Nick Clegg now making clear that he cannot sell the Bill to his party without even more changes in the House of Lords.
Even among the unrepresentative group who turned up, a few, including the Royal College of Paediatrics and Child Health, expressed reservations about the Bill - only to have their comments brushed aside and ignored by Cameron, insisting that the government would press ahead regardless.
To make matters worse for Cameron, campaigners had swiftly organised a vocal picket outside Downing Street and Andrew Lansley walked straight into it, to grab all the wrong type of headline news as he was assailed in front of TV cameras by veteran campaigner June Hautot.
The issue grabbed the attention of the wider public for the first time and opinion polls immediately afterwards show a sharp drop in Tory support and a further slump for the Lib Dems, with Labour leader Ed Miliband rightly branding the Bill as "Cameron's poll tax."
Some 52 per cent of the public now want the Bill dropped, while a few weeks ago hardly anyone knew of its existence.
This high-profile tactical disaster came alongside clumsy efforts by various health bosses to gag health professionals who speak out publicly against the Bill, invoking a spurious "code of conduct."
Among those victimised in this way are hospital staff in Newcastle who had heckled Cameron on a disastrous visit and the county medical officer of Cumbria, Professor John Ashton, who responded by giving an angry interview to Channel 4 News demanding an apology from Lansley, while the Department of Health tried desperately and unconvincingly to claim it had not been involved.
Meanwhile, in the real world, all of the key organisations central to implementing the Bill are hardening their opposition to Lansley's underlying plan to break up the NHS into a competitive market and slice off an ever larger share of its £100 billion budget for profit-seeking private providers.
The BMA, the Royal College of GPs and the Royal Colleges of Nursing and Midwifery were all excluded from Cameron's summit meeting.
An ever-growing number of medical royal colleges are reporting polls of members showing 80-plus per cent opposed, and declaring their opposition.
So too has the Faculty of Public Health, the Allied Health Professionals and now the two big organisations representing senior management - the trade union Managers in Partnership and the professional body the Institute of Healthcare Management (IHM).
The IHM published a survey of its members showing 87 per cent opposed, 82 per cent believing the IHM should oppose the Bill, 80 per cent saying it would not result in cost savings or reduce bureaucracy and 85 per cent saying it would increase the involvement of the private sector. Some 75 per cent thought it would bring a more fragmented system.
With almost every sector of professional opinion and the health unions lined up against it, the Bill is more dependent than ever on the suppression of embarrassing information if it is to make it through the House of Lords.
In this, at least Cameron and Lansley have been able to count on coalition MPs.
British politics hit a new low with the vote by MPs last week to keep themselves in the dark on the NHS reforms and uphold Lansley's right to defy the Information Commissioner's instructions to publish the embarrassing "risk register" that exposes the dangers of his plans.
Coalition MPs have willingly allowed themselves to be lied to about a Bill they have clearly not read or understood, and obediently closed their eyes and ears, held their noses and voted through Lansley's legislative lash-up - only to see ministers to concede hundreds of amendments in the House of Lords to clauses nodded through months earlier in the Commons.
Lib Dem peers, too, have now swallowed the camel and voted to end the Secretary of State's duty to provide comprehensive and universal health care, although it seems that some may now strain at the gnat and baulk at some of section three of the Bill, which rolls out a new competitive market system.
Tories have been more gung-ho, but there is increasing evidence of divisions among the Tories right up to Cabinet level as the damage the Bill is doing to the government's credibility becomes more obvious for all to see and Cameron's lead over Labour on the NHS has melted away.
Many Tories will also be shocked to see Lansley's Bill savaged by instinctively Tory-leaning newspapers, with devastating coverage in the Telegraph, the Times revealing a Cabinet insider suggesting Lansley should be "taken out and shot," the Daily Mail exposing the growing influence of private consultants McKinsey, critical articles in the Financial Times, the Independent and even the Sun flagging up the slump in Tory poll ratings driven by the Bill.
All three leading health journals, the British Medical Journal, the Lancet and the Health Service Journal, have published a joint critique of the Bill.
And the bad news keeps coming. Some of the GPs most eager to promote the Bill are now warning that they may not get the level of control of commissioning they had expected.
In Stafford, a GP commissioning group is already planning to pull the plug from its local A&E unit, threatening local people with the greatest emergency health needs with much longer journeys to access A&E services in other cities.
And in south-east London there are rumours that the basket-case South London Hospitals Trust, spanning Greenwich and the two Tory heartland boroughs of Bexley and Bromley, could be allowed to go bankrupt, raising doubts over two costly PFI hospitals - Queen Elizabeth in Woolwich and Princess Royal in Bromley.
Even Lansley's attempt to get some favourable publicity through a £1.5 billion bailout of seven of the most financially desperate trusts weighed down by costly PFI hospital contracts has misfired, with vicious strings attached to the new money, while it leaves another dozen potentially bankrupt trusts saddled with unaffordable PFI schemes.
The rescue plan is a transparent effort to subsidise PFI at taxpayers' expense, while Lansley has continued to sign new deals - £750m worth last year- and hopes to leave PFI intact as a profit stream for the private sector.
This is no accident. The Bill is effectively a smash-and-grab raid on the NHS, from which the only real beneficiaries would be the private sector.
While Lansley and his stooges keep on denying that they are privatising, that's exactly what they are doing.
It's privatisation that dare not speak its name and is desperate to have the facts suppressed or prevent critics speaking out publicly.
Despite his inept "four Fs" pledges, Cameron does not give a FFFF for the NHS.
He has made the Bill that will destroy it as a public service a point of pride - just as Thatcher did with the poll tax.
But while some may celebrate the fact that the Tories would certainly pay a heavy electoral cost for smashing the NHS, the priority now must still be to keep on the pressure to kill the Bill.
The TUC day of action on March 7 offers another chance to reach out and alert the wider public, and unite health workers and professionals in one last heave to stop the vandals in their tracks.
John Lister is director of Health Emergency.
The TUC rally to Save Our NHS is on March 7, 6pm-7.30pm at Central Hall, Westminster. For more information visit www.tuc.org.uk
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