Relations between health secretary Andrew Lansley and the BMA hit an all-time low this week, descending finally into a good old-fashioned slanging match.

Amid all the animosity, it’s easy to forget that when the White Paper Liberating the NHS surfaced in July 2010, the BMA’s initial response – and that of many other organisations representing health professionals – was cautiously optimistic.

Many of the Health Bill’s most ardent critics were initially prepared to back it because there is overwhelming support among health professionals for NHS reform. Although 98% of RCGP members now want the Health Bill withdrawn, it’s a fair bet that roughly the same proportion accept that the NHS is far from perfect as it is.

GPC deputy chairman Dr Richard Vautrey said this week that ‘no one believes the NHS does not need to change to respond to challenges coming over the next decade’.

Given that this consensus exists, it is remarkable that rather than harness it, the Health Bill has come to symbolise an attempt by the government to wreck key principles that underpin the NHS. It is even more odd that the Health Bill is the brainchild of a health secretary who spent half a decade in opposition wooing the medical profession, with some success.

Some prominent health commentators still believe Mr Lansley to be a man who has no intention of privatising the NHS or steering it towards the co-payment, insurance model some now fear.

What has allowed these fears to run and run is the fact that Mr Lansley’s approach to discussing his reforms has been far more confrontational than collaborative. Most of the organisations now opposed to the Health Bill – the BMA, the RCGP, the Royal College of Nursing – say their opposition is founded on the fact that they feel their concerns  have been ignored.

Mr Lansley’s comments in a speech this week seemed to encapsulate the problem. He said: ‘I’ve paused. I’ve listened. I’ve worked with the independent Future Forum. I’ve reshaped the plans where my critics have a case.’

Working with the Future Forum did not convince organisations representing health professionals that they were being listened to. And reshaping plans ‘where my critics have a case’ smacks of the dismissive attitude  that has angered many expert health organisations that have expressed opinions on the reforms.

The ‘pause’ was an opportunity to rebuild support for reform that the government and Mr Lansley failed palpably to grasp. Until the health secretary can bring himself genuinely to engage with health professionals and their representative organisations to build a consensus on shaping NHS reform, they will continue to fear that his motives are not simply to improve the NHS, but to destroy it.