A Tory spokesman struggled to hide his irritation on Sunday as the row over the NHS gathered pace. “In a broad church there will always be people with different views,” he said. “What is important is the people who set the policies at the heart of the party, where there is no dissent at all.”

Daniel Hannan may be a single voice, a rightwinger verging on the “eccentric” – the adjective party leader David Cameron attached to his views on the NHS. But the desire to replace the NHS with a more efficient – and cheaper – system of healthcare is widely shared among party grass roots.

A recent survey by Conservativehome, the activist website, found only a third agreed with Mr Cameron’s policy of ringfencing health spending. Barely any – just 4 per cent – wanted the budget for international aid maintained.

Mr Hannan’s increasingly strident interventions in the debate are a genuine threat to party discipline. They come at a point where the Tory leader seems more vulnerable than he has been for months.

Last week’s failure to punish Alan Duncan, the shadow leader of the Commons – for complaining that MPs had to get by on “rations” – has been criticised in some quarters. Mr Duncan may have been joking but, coming from the man charged with leading Tory attempts to clean up parliament after the expenses scandal, his remarks struck many as jarring.

And the Independent on Sunday reported that Mr Cameron had taken 60 private flights with business leaders since becoming Tory leader, a disclosure apparently at odds with the leader’s public commitment to the environmental agenda.

Some observers are drawing parallels with Tony Blair’s attempts to hold his party together ahead of his entry into Downing Street.

“It is a perennial truth that leaders taking their parties to the centre ground will all have to endure sniping from the left or right,” John Curtice, professor of politics at Strathclyde University, told the Financial Times. “The instincts of Conservative supporters are to support a smaller state; ringfencing the NHS means less money for areas they do support like defence or law and order.”

Earlier this summer Labour mistakenly thought it had the Tories on the ropes over the health service when Andrew Lansley, shadow health secretary, admitted that ringfencing the NHS could mean cuts of about 10 per cent to other departments.

But Labour’s refusal to concede that this was based on their own forecasts put them at a disadvantage.

Now, by contrast, the government seems to be back on the front foot, following Gordon Brown’s heartfelt expression of his love for the NHS on Twitter last week. By Friday, Mr Cameron had caught up, issuing a similar statement.

But the row will serve as a reminder that as much as he wants to present a kindly, “modernising” front, his grassroot members may not always see things his way.

Two polls on Sunday showed that support for the Tories remained strong; up 2 points to 43 per cent, according to ICM, and unchanged at 42 per cent from YouGov. These were taken mid-week, however – before the NHS row had reached critical mass.

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Up to 25 seats targeted by anti-sleaze campaigners

The Lincolnshire constituency of Alan Duncan, the Tory MP, will be among up to 25 targeted by a loose affiliation of anti-sleaze campaigners led by Martin Bell and Terry Waite.

Mr Bell told the FT he was unlikely to stand for parliament himself next year because he is now 70.

However, his new “honest politics” alliance with Mr Waite has gathered a list of “interesting people” who could stand in seats occupied by MPs embarrassed by the expenses revelations in May.

Mr Duncan was caught on camera last week moaning that MPs were paid “rations” and treated like “shit” by the public.

Mr Waite, former Church of England envoy – who spent four years as a hostage in Lebanon – is likely to target the seat of Tory MP David Ruffley, who tried to claim for a £2,175 television from Harrods.

The alliance will not reveal its candidates until closer to the general election. “There are some seats where MPs are not stepping down which will be easier for an independent to take down rather than a member of a regular party,” said Mr Bell.

Other MPs in their sights include Hazel Blears, former communities secretary.

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