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| Version 14 | Version 15 |
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| Government fights off Labour challenge to NHS plans | Government fights off Labour challenge to NHS plans |
| (about 2 hours later) | |
| The government has fought off a Commons challenge to its controversial plans to shake up the health service in England. | The government has fought off a Commons challenge to its controversial plans to shake up the health service in England. |
| MPs rejected a Labour call for the proposals to be abandoned, but the coalition's parliamentary majority was cut by more than a third. | MPs rejected a Labour call for the proposals to be abandoned, but the coalition's parliamentary majority was cut by more than a third. |
| Labour called the changes "damaging and unjustified", and the Royal College of GPs said they risked "unravelling and dismantling" the NHS. | Labour called the changes "damaging and unjustified", and the Royal College of GPs said they risked "unravelling and dismantling" the NHS. |
| Ministers are promising "substantive" changes after criticism by Lib Dem MPs. | Ministers are promising "substantive" changes after criticism by Lib Dem MPs. |
| The Health and Social Care Bill would give GPs more control over NHS budgets, and give the private sector a greater role. | The Health and Social Care Bill would give GPs more control over NHS budgets, and give the private sector a greater role. |
| The Labour motion was defeated by 284 votes to 231, giving the government a majority of 53. No Lib Dems - some of whom have raised concerns about the plans - voted with the opposition although more than 20 did not vote at all and one abstained. | |
| The parliamentary debate was held after the government agreed to stop the progress of the bill underpinning the reforms. | The parliamentary debate was held after the government agreed to stop the progress of the bill underpinning the reforms. |
| Last month ministers said they wanted to have a pause - despite the bill already having started to make its way through parliament - to carry out a "listening exercise" over how the plans could be improved. | Last month ministers said they wanted to have a pause - despite the bill already having started to make its way through parliament - to carry out a "listening exercise" over how the plans could be improved. |
| A decision on how to proceed is expected in mid June. | A decision on how to proceed is expected in mid June. |
| During the debate on Monday, shadow health secretary John Healey called for the government to shelve the plans, warning they were "high risk, damaging and unjustified". | During the debate on Monday, shadow health secretary John Healey called for the government to shelve the plans, warning they were "high risk, damaging and unjustified". |
| The current NHS proposals were drawn up not just by the Tory Andrew Lansley but by his Lib Dem Deputy Paul Burstow. | The current NHS proposals were drawn up not just by the Tory Andrew Lansley but by his Lib Dem Deputy Paul Burstow. |
| They were reviewed and approved not just by the Conservative Oliver Letwin but by Clegg's soulmate Danny Alexander. | They were reviewed and approved not just by the Conservative Oliver Letwin but by Clegg's soulmate Danny Alexander. |
| The foreword to them was signed not just by David Cameron but by Nick Clegg too. | The foreword to them was signed not just by David Cameron but by Nick Clegg too. |
| So they are, to coin a phrase, all in it together when it comes to the NHS. | So they are, to coin a phrase, all in it together when it comes to the NHS. |
| Both Cameron and Clegg realised too late the political danger of the reforms they'd agreed to. | Both Cameron and Clegg realised too late the political danger of the reforms they'd agreed to. |
| Both are now trying to reassure voters that they are not planning to privatise the NHS and to assuage the anger of hospital consultants and nurses who fear that GPs will not fund them as generously as politicians who, down the years, have found campaigns to keep hospitals open hard to resist. | Both are now trying to reassure voters that they are not planning to privatise the NHS and to assuage the anger of hospital consultants and nurses who fear that GPs will not fund them as generously as politicians who, down the years, have found campaigns to keep hospitals open hard to resist. |
| Both know NHS reforms that go wrong could destroy their personal as well as political reputations. | Both know NHS reforms that go wrong could destroy their personal as well as political reputations. |
| He told MPs: "This is setting up the NHS as a full-blown market and that is the wrong prescription for the NHS." | He told MPs: "This is setting up the NHS as a full-blown market and that is the wrong prescription for the NHS." |
| And he added such a move would lead to hospitals being "driven to the brink". | And he added such a move would lead to hospitals being "driven to the brink". |
| He was joined by other Labour MPs who criticised the plans. Former Labour health minister Ben Bradshaw said it was time to "go back to the drawing board". | He was joined by other Labour MPs who criticised the plans. Former Labour health minister Ben Bradshaw said it was time to "go back to the drawing board". |
| But Tory MPs attacked what they said was hypocrisy, pointing out that Labour had invited the private sector into the NHS while they were in power. | But Tory MPs attacked what they said was hypocrisy, pointing out that Labour had invited the private sector into the NHS while they were in power. |
| Pressure for change | Pressure for change |
| There is also political pressure within the coalition following significant unease within the Liberal Democrats. | There is also political pressure within the coalition following significant unease within the Liberal Democrats. |
| Nick Clegg has warned his party will block the health bill unless it is altered. | Nick Clegg has warned his party will block the health bill unless it is altered. |
| He said getting the NHS reforms right was "now my number one priority" and called for guarantees there would not be "back-door privatisation". | He said getting the NHS reforms right was "now my number one priority" and called for guarantees there would not be "back-door privatisation". |
| He also vowed to be a "moderating" influence on the Conservatives on issues such as the NHS - a marked change in tone from the early days of the coalition government. | He also vowed to be a "moderating" influence on the Conservatives on issues such as the NHS - a marked change in tone from the early days of the coalition government. |
| GPs are also questioning the proposals. | GPs are also questioning the proposals. |
| The BBC has seen a 26-page analysis sent by the Royal College of GPs (RCGP) to the Prime Minister's office. | |
| Some parts of the government plans are welcomed, such as the greater involvement of GPs in buying and planning care. | Some parts of the government plans are welcomed, such as the greater involvement of GPs in buying and planning care. |
| But it also challenges the need for a greater market in healthcare and, for the first time, calls for the entire section on competition in the bill to be rewritten. | |
| RCGP chairman Dr Clare Gerada told the BBC the changes needed went far beyond any modest alterations. | |
| She said: "I would hope that during this pause the government will reflect on what we're all saying and will rewrite the part of the bill that is actually risking the NHS and risking the NHS being unravelled irreversibly for ever." | She said: "I would hope that during this pause the government will reflect on what we're all saying and will rewrite the part of the bill that is actually risking the NHS and risking the NHS being unravelled irreversibly for ever." |
| She said one fear was that it could lead to an "insurance-type model" of healthcare with patients being charged for certain services. | She said one fear was that it could lead to an "insurance-type model" of healthcare with patients being charged for certain services. |
| 'Stronger future' | 'Stronger future' |
| Health Secretary Andrew Lansley said the reforms were about ensuring the NHS had a "stronger future". | Health Secretary Andrew Lansley said the reforms were about ensuring the NHS had a "stronger future". |
| But he added he was prepared to make changes to his plans if necessary. | But he added he was prepared to make changes to his plans if necessary. |
| "I have been clear that there will be substantive changes to the bill if they deliver improvements for patients. There is only one issue for me. Will it deliver better care for patients?" | "I have been clear that there will be substantive changes to the bill if they deliver improvements for patients. There is only one issue for me. Will it deliver better care for patients?" |
| He also accused Mr Healey of having "no ideas of his own". | He also accused Mr Healey of having "no ideas of his own". |
| Separately, Prime Minister David Cameron has rejected suggestions that there was no mention of the proposals in the coalition deal agreed between the two partners a year ago. | Separately, Prime Minister David Cameron has rejected suggestions that there was no mention of the proposals in the coalition deal agreed between the two partners a year ago. |
| He told a Dispatches special on Channel 4 that the "key elements of what we are proposing" - including greater GP-led commissioning and payment by results - were included in each parties' manifestos before the election. | He told a Dispatches special on Channel 4 that the "key elements of what we are proposing" - including greater GP-led commissioning and payment by results - were included in each parties' manifestos before the election. |
| And he described the plans as "an evolutionary programme". | And he described the plans as "an evolutionary programme". |