THE fact that David Cameron is having to reaffirm the case for making fundamental changes to the National Health Service shows the extent to which the Government is on the defensive on an issue perhaps closest to the nation’s heart.

Nick Clegg has identified the NHS as the battleground on which to reestablish the Lib Dems’ credibility, warning that his party will block the proposals unless they are altered.

And, with rumblings of discontent growing louder from NHS professionals, the Prime Minister has been forced to defend plans which were not included in the coalition agreement.

It is a tricky balance for Mr Cameron to find: he must show that he is listening to his coalition partners and the NHS professionals, without suggesting that he will be held to ransom by watering down his proposals too far.

Hence we have a message from the Prime Minister that there will be substantial alterations to the proposals – but no one should be under any illusion that major changes are needed and will be implemented.

Changes can and should be made to the NHS to help it cope with the increasing demands of society. There are areas of waste and duplication which can be tackled, but it is a question of the scale and pace of change.

Mr Cameron faces a difficult challenge: he must keep Nick Clegg on board; take NHS professionals with him; and calm public fears that he is opening the door to the private sector so that it can cherry pick the most lucrative services.