The Liberal Democrats take their party policymaking process seriously, as we see in the explosive intervention from Norman Lamb MP (Nick Clegg's consiglere and political adviser) on today's BBC Politics Show.

Lamb, Deputy Prime Minister Clegg's chief political and Parliamentary adviser (and also chair of the Lib Dems' federal policy committee) makes it quite clear that there is no evidence base for how GP commissioning consortia will work; that the financial risk involved is huge; and that there are risks to the principle of clinically-led commissioning by getting the process wrong - which, he implies, is what is currently happening.

If the change he requires is not delivered, Lamb told Jon Sopel that he will step down, saying "it would be incredibly destabilising politically if we get this reform wrong".

I stated at the time of the Lib Dem spring conference here and here that the new Lib Dem health policy placed the Coalition parties at loggerheads.

I was not wrong.

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In politics, as in comedy, timing is everything. Lamb is a smart man, and also in my experience of him, a decent one. I interviewed him in June 2008, and made the relatively shrewd prediction that "The electoral arithmetic is starting to look brighter for Westminster’s third party than it has for decades. True, the Conservatives enjoy a daunting lead in opinion polls, but the election is not tomorrow. Events and smart tactics have been benevolent to them – yet the degree of swing needed to put them straight into power still feels unlikely".

(Anybody wanting to know what numbers will win the lottery next week should subscribe to Health Policy Intelligence forthwith).

There will be speculation that this is a negotiating tactic. My sense it that it is anything but. Lamb seems under real pressure during the broadcast, and I don't think he's acting at all.

This is for real. Lamb is not dumb: he recognises the political toxicity of the Health Bill.

That is why he is heaping on the pressure for a major change - one that would effectively defenestrate the most destructive bits of Secretary Of State For The Time Being Andrew Lansley's dismal liberation theology.