Colonel Gaddafi may have benefited from the rival distraction of Japan’s apocalyptic tsunami, but Andrew Lansley has no such luck. As HSJ’s editorial asks if he is “screaming inside”, wave after political wave rolls over him.

Where to start? I had planned to concentrate on the one month reprieve the health secretary granted to Chase Farm Hospital in Enfield, North London. By general consent it is a test case of his will to see hospital restructuring pushed through despite local anger.

Since when six big players have walked out on his voluntary “responsible drinking” deal before it was even launched. They complain that Mr Lansley failed to consult and has put the drinks industry’s views first. He insists they’ve all got it wrong. Sounds familiar, eh? Ditto the BMA rebels.

But the biggest blow is likely to prove the assault on the coalition’s Health Bill at the Lib Dem spring conference in Sheffield. Damaging publicity would have been far worse but for Japan’s tsunami. But even at age 80 Shirley Williams has a knack for headlines and her co-plotter, ex-MP medic Dr Evan “Bomber” Harris, is a good organiser, if sometimes reckless.

In his own conference speech Nick Clegg said all the right things: no to Labour “scaremongering” and no to NHS privatisation, yes to a publicly funded, patient centred service. He and Lansley signalled flexibility and constant “review” of the bill - true enough, 100 government amendments are in the works.

Watching grassroot Lib Dem anger (“don’t trash the NHS”) from the balcony in Sheffield, Labour spokesman John Healey was quick to challenge the health secretary to prove his good faith by accepting Labour’s amendment to ditch the new competition regulator, Trojan horse for the private sector. Fat chance, that is exactly the kind of “scaremongering” Clegg deplores.

I read the Bomber Harris amendment to Paul Burstow’s pro-reform motion in Sheffield as a serious blow to the bill if Lib Dem MPs do as instructed by their conference. Yet Tory friends told me it didn’t bother them.

Price competition? Private sector cherry-picking of services? “They require tweaks, but nothing of substance,” I am assured. And: “when was health reform ever easy?”

So Mr Lansley’s legendary calm prevails as the waves loom over him, despite challenges over GP led transparency and accountability, not to mention freedom of information.

So what about Chase Farm? When I rang Nick de Bois, Enfield’s local Tory MP, he was upbeat about the hospital’s chance of finding “a credible, viable outline alternative” to save its A&E and birthing services. Mr Lansley’s decision reflected his pledge that local people must decide, the MP argues.

Yes, but how? Sensibly, the MP says it’s not for him to decide, although there is a good demographic and strategic case for A&E here. Andy Love, Labour MP for neighbouring Edmonton, sounds more cautious. He agrees Lansley’s four tests are not yet met, but clearly doesn’t think a month’s reprieve offers much hope after years of wrangling.

I can sense how strongly public opinion feels (an awkward council by-election looms) and there might be some flexibility in a partial reprieve of A&E in a rebuild paid for, in part, by a sell-off of valuable surplus land for housing. But the awkward fact is that £125m has been spent on a PFI funded deal to rebuild nearby North Middlesex hospital.

Unless it gets some of rival Chase Farm’s income stream it could flounder. All this politicking pre-dates the disruptive Lansley era reforms.

“This could be worse for us than tuition fees,” mutter Lib Dems.

The coalition’s de facto majority of 80-ish is not as solid as it looks.