He is thought to be willing to sacrifice almost anything to achieve this aim - even Mr Lansley, a man he has close personal links to and who was his boss when he was a young researcher for the Tories.
The key point is whether the changes to the Bill can be presented as significant - but not requiring the measure to return to the committee stage in the Commons, where it would be debated in detail again by MPs.
This would be an outcome which could allow Mr Lansley to stay on, although his reputation would still be damaged.
However, the signs were this weekend that the changes would be so big the Bill would have to go back into committee. This is a key demand of Mr Clegg, the Deputy Prime Minister, and could trigger Mr Lansley's resignation.
A fellow Conservative minister said last night: "I have immense personal sympathy for Andrew but if the Bill becomes something totally different from his original proposals then he will simply not have the credibility to lead the reforms."
A key concession on the Bill has already been accepted, according to Whitehall sources.
As first disclosed in The Sunday Telegraph, GPs will no longer be forced to join consortia from 2013, the planned start date for the reforms.
However, this newspaper has learned that fierce debate continues to rage on four main points of the Bill.
- Mr Clegg is battling over the role of the new NHS regulator, with demands that it should only improving "collaboration" rather than driving competition between providers, including private sector ones, which Mr Lansley says is necessary to improve services.
- Mr Lansley is said to be "digging his heels in" over plans to open up consortia to other clinicians rather than simply a "closed shop" of GPs. In this he is clashing dangerously with Mr Cameron and No10, who favour wider membership.
- Lib Dems are pushing for even wider membership of consortia to provide "patient and public involement" - even to the extent of allowing counsellors to sit on them. Tories fear such a move would see a return to the over-bureaucratic NHS structures of the recent past.
- Hospitals are protesting about the likely blow to their educational and research functions if GP consortia simply commission work from elsewhere.
Mr Lansley last week raised the stakes by claiming driving his reforms through was now his "only political goal," adding provocatively: "I don't want to do any other cabinet job."
If, however, he is forced to resign and the changes are seen as major political "win" for Mr Clegg and the Lib Dems, Mr Cameron will face further trouble from his own backbenchers, some of whom mobilised last week to "protect" the original reform proposals.
Meanwhile, hospitals across the country have been told to get rid of their patients much quicker, under plans to cut costs, an investigation has found.
Under savings plans agreed by NHS managers, the average ward stay must be reduced by more than one quarter in just 12 months.
Under the targets, according to the doctors' magazine, Pulse, the average hospital stay must be cut by 26 per cent by next April. It currently is 5.6 days.
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