The good news for the Lib Dems is that they are now a party of government. You might not think it, if you've followed the coverage of their party conference this week as regards their health policy.

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Firstly, the bid to have an emergency debate on health policy was defeated. It's instructive to think back to what happened at the Lib Dems' spring conference, and what it looked likely to mean.

It hasn't meant much in practice. The Lib Dems have been fighting the Conservatives to win the credit for revising the Health And Social Care Bill. Yes, the Bill that both parties' MPs all supported at first reading and throughout committee stage, with very few exceptions.

Yesterday, Baroness Williams reiterated her opposition to the Bill, promising that it will get the Humpty Dumpty treatment in the House of Lords.

Health Minister Paul 'Who?' Burstow hinted yesterday that there could be further changes in the Lords, to clarify the accountability of the Secretary Of State.

The SOS accountability issue has bothered others considerably. While the points made are interesting legally and constitutionally, there is, ultimately, no way that the public will ever accept that there is anything other than political accountability for the NHS lying with the Health Secretary of the day.

Waving goodbye to services - and seats?
Today's Telegraph reports Minister 'Who?' as heralding
"a wave of reconfiguration decisions".

'Who?' is quite right about this. These are long-ducked issues, for which Labour (and in some cases, the Conservatives before them) must take discredit.

The problem is that the public has been so poorly prepared about the need for the coming changes. Service closures are rarely popular.

The question that Lib Dem activists and MPs (who, overall, seem to have been remarkably upbeat at their conference) will be wondering is whether this wave of closures is going to be associated with waving goodbye to seats in local or national government.

Kidderminster casts a long shadow. As Enfield North MP and Health Bill committee member Nick de Bois would probably agree.

The emergency debate on the NHS reforms was hard to follow owing to the very variable quality of the BBC's streaming, but views were not mainly positive. Simon Hughes has just told Andrew Neil on BBC2's Daily Politics that "there's a lot of work still to do on the Bill ... it's by no means over ... there are three of four significant things still to be done ... we need to absolutely tie down that private work in any NHS hospital cannot become the dominant activity or the driver".

Which makes you wonder why Lib Dems have voted for the Bill with such consistency.

These NHS reforms are huge in scale. They do not command a majority of support in the national media, the trade press, the medical profession, academics and think-tanks: it's not just the BMA. Those who must deliver these reforms in practice are broadly split between ambivalence and opposition.

There is significant risk that the current slowdown to flat real-terms growth, coming after a decade of consecutive annual 6% real-terms cash growth lavished on the NHS, will see waiting times grow, and public satisfaction fall.

Perhaps Lib Dem leader and Deputy Prime Minister Nick Clegg will address the issue in his speech, which is scheduled for 3.00 this afternoon.