David Cameron is said to be willing to endure three final months of political controversy to push the health bill through parliament, but is convinced there is no serious dissent in his cabinet, parliamentary party or in the country at large.
No 10 argues that if the coalition did suddenly drop the bill, as some ministers are privately suggesting, the Conservatives would still be unable to avoid the political blame for closures and job losses likely to happen anyway due to long-term financial pressures on the NHS.
Government sources turned their fire on Tim Montgomerie, editor of the influential Conservative Home website, who, citing the support of three cabinet ministers, wrote an editorial arguing the NHS bill was "potentially fatal to the Conservative party's electoral prospects" and "must be stopped before it's too late".
Montgomerie claimed he had been virtually instructed to write the opinion piece by Conservative cabinet members likening the NHS bill to the poll tax. He declined to identify the three cabinet members concerned.
Andrew Lansley, the health secretary, retains the confidence of the prime minister and insisted he was not going to resign to get the bill through parliament. "It is not about me," he said.
One government source was scathing, referring to Montgomerie's links to Iain Duncan Smith, the work and pensions secretary and former leader of the Tory party: "Tim's sole achievement in politics was to be chief of staff to the most unpopular leader in Conservative history, so forgive us if we don't take any lessons from him. He clearly wants to take the party back to the bad old days of constant infighting and no policy.
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No 10 was more restrained, but strongly denied any cabinet ministers have complained directly to Cameron, or that the parliamentary party is in a state of revolt. One senior figure in the 1922 committee admitted the politics of the bill were dire, but said it would be worse to backtrack.
It was also stressed that the chancellor, George Osborne, was fully behind the reforms, and Liberal Democrat peers will ensure the bill reaches the statute book over the next two to three months. By the time of the next election much of the shroud-waving about the bill will have been exposed as false, No 10 expects.
No 10 recognises that collectively the government lost some health professionals over the past few months, but dismisses opposition to the bill as intellectually inchoate. It also feels that if Labour attacks the bill on grounds that the bill extends choice or competition, Labour will be on the wrong side of the argument.
Ministers are sanguine, expecting the controversy to die down once the bill becomes law, even if they are concerned at the way in which the rightwing commentariat has lined up against the bill.
Labour believes the next 72 hours could be critical to the bill's fate. The party's leader, Ed Miliband, took the unusual step of writing to all peers to reiterate a Labour offer "to put party differences aside and work with the government on reform objectives we all share, such as greater clinical involvement in commissioning and the funding of social care".
In a riposte on Conservative Home, the Tory co-chairman Lady Warsi claimed the bill represented "the most radical decentralisation of power that the NHS has witnessed in its history. As Conservatives it is our duty to support it. It passes power to patients. It gives control over the NHS budget to doctors and nurses, and gives greater freedoms to hospitals. It cuts out £4.5bn of bureaucracy. It is in every way a bill that hands power to the frontline."
In a bizarre twist, the Liberal Democrats, who have been wracked with internal divisions over the bill, called on their coalition partners to get a grip.
The Lib Dems were pointing to the way in which Baroness Williams on BBC1's Question Time on Thursday night had staunchly defended the revised bill.
But in a sign that Tory dissent is already stirring up Lib Dems, two left-leaning liberal groups, the Social Liberal Forum and Liberal Left, released separate statements calling for the controversial aspects of the bill to be dropped.
The SLF said: "Where the reforms underway enhance the social liberal aspects of the healthcare system, they should be completed with little further disruption, agreement across parliament and in concert with the medical profession.
"The rest of the bill should be abandoned in the interests of preserving a locally accountable, co-ordinated, comprehensive and co-operative [NHS]."
Liberal Left, in a letter to Clegg, argued that "the bitterness in the party, amongst professionals, and most importantly in the country, should now lead the government to cut their losses – show a little leadership and admit they got it wrong".
Dr Clare Gerada, chair of the Royal College of GPs, said she was consulting fellow health professionals of all sorts, including nurses and NHS managers, about a possible "plan B" to replace the bill.
"Andrew Lansley means well, but his are the wrong reforms. What he's done is galvanise people to talk about what's best for the NHS. There should now be an agreed 'plan B' as an alternative to the bill which would make the NHS safe in the first instance and then take it forward in the longer term," Gerada said.
The Department of Health is bracing itself for a potential second defeat on the bill in the Lords on Monday.
Government sources say that peers may well succeed in voting through an amendment which would put the NHS under a new legal "duty of candour" to admit when blunders are made that harm patients, and explain what happened.
The Royal College of Surgeons of England, which two weeks ago wrecked what would otherwise have been a united front against the bill by all of the royal colleges of medicine and associated faculties, is under pressure to adopt a more hardline stance against the bill.
