Leading article: An impression of drift that Mr Cameron must dispel

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Opposition from medics' professional bodies was one thing; the most influential Conservative grassroots website weighing in against the Government's NHS reforms is quite another.

But even the ConservativeHome verdict that the Health and Social Care Bill should be scrapped – a view it claims is supported by no fewer than three Tory cabinet ministers – is not the most serious of the Prime Minister's problems.

What should be even more alarming for David Cameron is that the fracas over the NHS is only one of a growing list of Tory rebellions that, taken together, points to a dangerous lack of clarity at the heart of his Government. The risk is that the ability to govern is lost in an endless squall of noisy protests. The question is whether Mr Cameron has what it takes to resolve the situation.

Given his record so far, the prognosis is not altogether promising. Indeed, the health service reforms by themselves must put a serious question mark over Mr Cameron's political judgement. Having used his commitment to the NHS as a totem for the new kind of Conservatism he claimed to represent, as Prime Minister he then looked the other way while his Health Secretary put together a legislative behemoth with little apparent thought to either the political implications or the backdrop of £20bn worth of budget cuts. But critics' calls for Andrew Lansley's head are misplaced: it will take more than the Health Secretary's dismissal to solve the problem.

Similarly, by making a show of using Britain's European veto, only to have the emptiness of the gesture exposed barely more than a month later, the Prime Minister has stoked the ire of the Eurosceptics where he meant to placate them.

Then there is Coalition energy policy, which is also under attack, most recently from 101 Tory MPs calling for dramatic cuts to wind farm subsidies. Given that a government billed as "the greenest ever" has been marked out by its incoherence and backsliding, is it any wonder that Tory naysayers hope to exploit the situation?

The difficulty for the Prime Minister is that this is no single cohort of rebels hammering an unpopular leader any way they can. It is too easy to characterise Mr Cameron's troubles as those of the centrist reformer battling his dyed-in-the-wool right wing when they are no such thing. On both the NHS and Europe, the Prime Minister is well to the right of centre.

Rather, these are three separate questions, drawing fire from backbenchers with very different priorities – from concerns about losing the election, to visceral Euroscepticism, to resentment at concessions to the Liberal Democrats. Each issue is different; each requires a different response. Add in the fact that, unlike most prime ministers, coalition-bound Mr Cameron cannot ease the grumblings of his backbenchers with promises of ministerial jobs to come, and the situation is troublesome indeed.

In fairness, the Prime Minister is in an unenviable position. His scope to act is curtailed not only by the Coalition, but also by the coming general election and by the grim economic conditions. No matter. The common theme behind all the isolated sources of rebellion is the sense of drift at the top. It is this that Mr Cameron must address. And, as leader, it is his job to do so. For the six years since he took over the Tory party, Mr Cameron has sidestepped political clarity. The stresses are starting to show, and the fiasco over the NHS is only the most toxic sign of them. It is time for the Prime Minister to demonstrate real leadership and give his Government a clear sense of direction. He does not have long.

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