The opponents in the House of Lords of any reform of the NHS have pursued two tactics - firstly, they have sought to delay the Bill for as long as possible and, secondly, they have raised a whole number of "straw men" of horrors and havoc that they assert would be unleashed if the NHS were to be reformed.

In an attempt to demonstrate what indeed everyone - including the critics of the Bill - know to be the case that the Government does not and never has had the intentions ascribed to the Bill by its critics in the Lords, Ministers have sought to amend the Health Bill to make it clear beyond a shadow of a doubt what the Bill is intending to do.

But of course the critics in the House of Lords don't wish to be reassured.

They are instinctively opposed to any reform whatsoever of the NHS.

As a consequence, the Lords' amendments are becoming more incoherent.

Last week, the Lords passed an amendment saying that in providing a universal Health Service, the NHS should have proper regard for mental health.

Of course it should - but the amendment could as equally have said that the NHS should also have proper regard for:

• Cancer services
• Preventative medicine
• Concern about neurological disorders
• Palliative care
• Respiratory diseases

or a host of other causes and conditions that one would expect in any comprehensive 21st century health system.

The fact is that the realities concerning the NHS are the same now as they were last year or the year before when the Labour Party signed up to the Nicholson Challenge.

The Nicholson Challenge which makes it clear that there needs to be efficiency savings delivered in the NHS, made without harming patient care and that these challenges and the challenges for the NHS will grow with a growing, ageing population.

The issue is - as it has always been - with finite resources for the NHS, do we want decisions about medical priorities taken by managers acting on the instructions of political masters or do we want priorities set by GPs, clinicians and healthcare professionals, acting in the interests of their patients.

I think the overwhelming majority of people would prefer the latter and GPs in my constituency and elsewhere are repeatedly making it clear that they too want to be able to design health services for their patients.

GPs want the procrastination to stop - they want to get on with GP commissioning.

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