Two votes of no confidence in the government's NHS reforms have been comfortably defeated but other developments mean that ministers face at least two further major challenges to the legislation in the final week before the bill is due to be passed.
MPs voted twice on Tuesday on motions to drop the health and social care bill after Labour held a three-hour opposition day debate inspired by a public e-petition signed by more than 174,000 people calling for the government to abandon the legislation.
The first vote was on a Liberal Democrat motion calling for the bill to be dropped in its current form and urging health professionals and critics to work with the coalition government on further reform of the NHS. Despite earlier hopes of a bigger cross-party uprising, the motion was defeated by 260 votes to 314 in support of the government – a majority of 54, compared with the government's overall majority of 84. A second vote on a simpler motion by Labour to simply drop the bill was defeated by 258 to 314.
Ministers are reported to want the bill passed into law on 20 March, a day before the budget. Some critics of the bill have vowed to keep fighting until then.
On Wednesday the Department of health will be under pressure to respond to a ruling that it was wrong to refuse requests to publish a risk register of the reforms when the tribunal publishes its reasons for doing so.
And the former SDP leader and now cross-bench peer Lord Owen has tabled an amendment calling for the final reading of the health and social care bill in the House of Lords to be delayed until the risk register is published. The move will put pressure on Lib Dem peers, whose party members last weekend refused to vote at their spring conference for a motion calling on them to support the bill.
In further pressure on government on TuesdayLabour's shadow health secretary, Andy Burnham, used the debate to expand his offer to co-operate with the government to agree on reforms such as GP-led commissioning of healthcare and "some principles… by which important service change in the NHS could be introduced". Later, Labour MP Joan Walley suggested other reforms endorsed by the Conservative-led health select committee could also be agreed by all parties, such as moving public health policy into local government.
Walley was speaking in favour of an amendment by five Lib Dem MPs to their opposition day motion calling on the government to drop the health bill which added in a call for an "urgent summit" with government, professional and patients' organisations to agree health reforms "based on the coalition agreement".
In response to the threat of a wider than usual coalition of support from rebel Lib Dems and some of the smaller parties for the anti-government motion, Conservative whips took the precaution of contacting MPs during the debate to remind them it was "imperative" they were in the House of Commons to vote.
The debate followed a day of good and bad news for the government's reforms. The Guardian revealed that senior GPs were spending as little as one day a week seeing patients as they had become so preoccupied with the reorganisation, raising costs as they employ locum doctors to cover their normal practice work. However the Royal College of General Practitioners, one of the bill's fiercest opponents, wrote to the prime minister, David Cameron, offering talks on the bill's implementation. Its chair, Dr Clare Gerada, said the organisation would still prefer the bill to be dropped, but that the time had come "to restate our similarities rather than continuously focus on our differences".
In the House of Lords on Tuesday the government also won a string of votes on amendments by Labour and cross-bench peers, including a motion calling for the third part of the bill - introducing more competition into the NHS - to be delayed until beyond the general election in 2015: the government won that, final vote of the day by 237 votes to 178, a majority 59.
Writing last week after the tribunal ruled that the risk register should be published, Lord Owen urged peers to vote for his amendment on Monday. "To go ahead with legislation, while appealing to the high court, would be the third constitutional outrage associated with this legislation," he wrote. "The first was to legislate within months of the prime minister promising in the general election that there would be no top-down reorganisation of the NHS. The second was to implement large parts of the legislation without parliamentary authority. The attempt to railroad this legislation through both Houses of Parliament has raised very serious questions about the legitimacy of this coalition government. Now at the last moment parliament has a chance to assert its democratic rights and the many Liberal Democrat peers, who know in their heart of hearts that this legislative procedure is fundamentally wrong, have the opportunity to stand by their principles." The Guardian
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