David Cameron and Nick Clegg admit it could take until election to persuade voters their fears are unfounded
David Cameron and Nick Clegg have agreed they have no alternative but to push ahead with the planned reforms to the NHS, even though they admit they are in "a rubbish place politically" and it could take three years until the general election to persuade voters that fears about the reforms are unfounded.
Cameron endured a mauling over the issue at prime minister's questions , and afterwards one senior minister involved in deciding how to proceed with the bill admitted: "This is a politically rubbish place to be. We can either go back, sideways or forward." Ministers have argued there was no alternative but to plough on.
Liberal Democrats, including Baroness Williams, are in no mood to abandon the bill, even though many health professionals – at one time reconciled to the bill – have now defected.
On the day that health visitors and the Faculty of Public Health joined the long list of those deserting the bill, Labour leader Labour leader Ed Miliband accused Cameron of presiding over a "complete disaster" with the bill.
He said the prime minister had broken a pre-election promise not to have any "top-down re-organisation of the NHS" and told him: "Every day he fights for this bill, every day trust in him on the NHS ebbs away, every day it becomes clearer the NHS is not safe in his hands."
But Cameron said Labour had previously supported NHS reform – and would not match government commitments on NHS spending: "They are not in favour of the money. They are not in favour of the reform. They are just a bunch of opportunists."
He criticised Labour's record on the NHS in Wales – where the party controls the Welsh Assembly – and said the coalition was cutting bureaucracy and ploughing money back into patient care.
He said of Miliband: "This is not a campaign to save the NHS. This is a campaign to try and save his leadership. I make this prediction, the NHS will go on getting better and his prospects will go on getting worse."
Cameron also backed his health secretary Andrew Lansley, saying he would survive a lot longer in office than Miliband.
It is understood that Lansley put in angry performance at cabinet this week defending his reforms, saying they were in line with government public services reform. He has been infuriated by leaks form Downing Street blaming him for mis-selling the reforms.
Although a Downing Street source has suggested Alan Milburn, the former Labour health secretary could be drafted into Lansley's role, Milburn himself dismissed the suggestion.
He criticised Lansley's handling saying: "This bill has ended up as a – to be frank – a patchwork quilt of complexity and compromise and confusion. They will get the measure through in my view, they will probably win the day in parliament, but at a terrible cost. The NHS will not have either the clarity or the direction that is necessary in a period of considerable challenge where it is being asked to make unprecedented efficiency savings."
In a sign that the government will face a tough month as the bill enters the Lords report stage, peers inflicted an early defeat over the issue of social care. By a margin of four votes, peers demanded mental health be made a higher priority. The amendment creates a duty for the health secretary to promote a health service that deals with "mental and physical illness", rather then the original draft of just "illness". The government described issue as largely symbolic.
All but three Lib Dem peers voted with the government, suggesting that on most issues Labour will rely on cross bench support to further amend the bill that has already been heavily altered by government to take on concerns of health professionals.
Meanwhile there was a fresh embarrassment to the reforms after part of a major risk assessment into the bill was published on the internet, suggesting that changes could lead to the financial "failure" of some NHS organisations, worse care for patients, and threats to maternity services, children's safety and public health.
Most worryingly for the coalition the "risk register" for the London NHS suggested that problems with implementing the new system could delay improvements to patients' health – even after a host of proposed "mitigation" measures to ensure a smooth transition.
The document, dated October 2011, was published by NHS London on their website, according to the Labour-supporting blogger Dr Eoin Clarke, who has waged a campaign to get the full national risk register published. At least nine Lib Dem MPs have also signed an early day motion organised by Labour MP and health select committee member Grahame Morris calling on the health secretary to publish the document.
Health officials have pointed out that such a risk assessment would be carried out for any major changes, but added that during the transition there was "more of a risk because of the uncertainty".
In a statement to the Guardian, an NHS London spokesperson said: "It is our job to identify and manage potential risks to deliver safe services for patients. We are duty bound to publish this information quarterly on our website and have done since our formation." These risks cover a wide range of services and issues, including how we manage the transition to 2013 appropriately. The more we plan for and pre-empt issues, the less of a risk they become." The Guardian