By Ian Dunt Follow @IanDunt
One of the final royal colleges to support the NHS reform bill will hold an extraordinary general meeting tonight to decide whether it should switch its allegiance.
The Royal College of Surgeons had previously refused to outright oppose the bill, preferring to engage with the government on specific issues, but it is likely to change its position when members and fellows vote on five separate statements tonight.
Next week, the Royal College of Physicians is likely to also join opposition to the bill after completing a survey of its members.
The decision by the two colleges would leave Andrew Lansley and David Cameron almost entirely friendless in their continued attempts to defend their NHS reforms.
Even backbench Tory MPs who privately support the bill are increasingly resistant to publically defending it, lest their comments are used against them on Labour campaign literature at the next election.
But the almost universal opposition to the bill, which included a well-attended march on Westminster last night, has done little to hinder its progress in parliament.
Labour peers were easily defeated in their attempt to stop it this week when Liberal Democrats, headed by long-term critic Baroness Williams, decided they had made enough changes to prevent excessive private sector involvement and backed the bill.
Those changes included allowing competition only in the interest of patients and based on quality rather than price, driving profits from foundation hospitals back into the NHS and building safeguards against conflicts of interest into the commissioning process.
There is still a chance that grassroots Liberal Democrat activists will halt the bill by adopting an emergency motion at their spring conference this weekend, however. A similar motion last year resulted in the 'listening pause'.
Labour is also hoping that a tribunal will rule on the publication of the NHS reform risk register. That would likely trigger another appeal by the government.
Some opponents of the bill believe cross-bench peers could be convinced to delay the bill until the register is published if the tribunal rules in that direction, giving opponents an extra month's breathing space. If not, the bill is likely to become law later this month.