Cameron defends health bill in Commons clash with Miliband

PM tells prime minister's questions that Labour leader should not 'set his face' against needed reforms

David Cameron stood firm on the government's health bill amid mounting opposition and Labour claims that the reforms are "threatening the fabric of the NHS".

The Labour leader, Ed Miliband, attacked the plans, which have come under fire in recent days from the British Medical Association and Liberal Democrat activists.

Cameron told MPs at prime minister's questions that the changes outlined in the health and social care bill would improve patient care and were about "abolishing" NHS bureaucracy, telling Miliband that he should not "set his face" against needed reforms.

The prime minister was pressed on the government's health reforms amid the first signs that dissent is spreading beyond unions and the opposition to Conservative ranks.

A cross-party motion signed by four Tory MPs ? Dr Sarah Wollaston, Charles Walker, Douglas Carswell and Anne Main ? urges ministers to listen to the concerns of patients groups, professional bodies and independent experts and work with them to achieve a strengthened NHS.

The motion, in the form of an amendment to a Labour motion due to be debated in the Commons on Wednesday, is a sign that Tory MPs are becoming concerned that Andrew Lansley, the health secretary, is not taking health professionals with him in his radical reform plans. The BMA voted on Tuesday to call for Lansley to withdraw the bill.

Miliband triggered a heated exchange when he seized on the level of opposition mounting against the bill to ask Cameron whether "any new" amendments would be made. Miliband said the bill "creates a free market free-for-all and threatens existing NHS services".

"He's threatening the fabric of the NHS," said Miliband. "This bill shows everything people don't like about this government. Broken promises, arrogant, incompetent and ignoring people who know about the health service. Doesn't it show once again, as the BMA said yesterday, as the Liberal Democrats said on Saturday, you can't trust the Tories on the NHS?"

The Liberal Democrats overwhelmingly passed a motion on Saturday calling on the government to refashion the reforms away from competition and marketisation.

A group of Liberal Democrat MPs led by Greg Mulholland has also tabled an amendment for Wednesday's debate calling for the health bill to be amended and agreeing with Labour that reforms represent a damaging and unjustified market-based reorganisation. Cameron told MPs that the bill had already been strengthened, but declined to answer directly whether any further amendments might be considered in future.

"These reforms were drawn up as a coalition to improve the NHS," said Cameron, "and to answer his question very directly we have already made some real strengthenings to this bill. First of all we have ruled out price competition in the NHS, and also the issue raised by the Liberal Democrats ? that I completely agree with ? that we must avoid cherry-picking by the private sector in the NHS."

He then turned his fire to Labour, adding: "He might care to reflect that under the last Labour government the private sector was given �250m for operations that were never carried out. Perhaps he'd like to apologise for that cherry-picking and support our anti-cherry-picking amendment."

Miliband said Cameron was "wrecking" Labour's record of new hospitals, shorter waiting times, and more doctors and nurses than ever before. He asked Cameron to confirm that the bill would make healthcare subject to EU competition law "for the first time in history". Citing clauses of the bill that related to competition, Miliband told him: "What's that got to do with healthcare?"

The prime minister pointed out that Labour's manifesto for the 2010 general election had promised that patients requiring elective care "would have the right in law to choose from any provider which met NHS standards and NHS quality".

Cameron said: "They were in favour of competition in their last manifesto. All that's changed is that they're jumping on every bandwagon, supporting every union, blocking every reform, and opposing the extra money into the NHS."

He added: "The fact is we support extra money going into the NHS, money that he doesn't support. What we recognise with an ageing population, with more expensive treatment, with new drugs coming on stream, [is that] we need to reform the NHS to go with the extra money that is being provided. Why is he setting his face against that?"

Cameron also warned Miliband against citing the BMA to shore up his argument. "He should remember the fact that the BMA opposed foundation hospitals, they opposed GP fundholding, they opposed longer opening hours for GP surgeries," said Cameron. "Isn't it typical that just as he has to back every other trade union, just because he has no ideas, he comes here and reads out a BMA press release."

H�l�ne Mulholland

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