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NHS reforms live blog - will the bill be dropped? NHS reforms live blog - will the bill be dropped?
(40 minutes later)
4.55pm: Here is a summary of today's key events:
• Andrew Lansley, the health secretary, has said it is not time for him to resign as health secretary despite his changes to the NHS in England coming under fire from influential activist website ConservativeHome, which reported that three unnamed Tory cabinet ministers are opposed to the bill (see 4.32pm). Ladbrokes made Lansley the 2/1 favourite for the next cabinet exit (see 3.24pm).
• Tim Montgomerie of ConHome joined a chorus of criticism of the bill - in his case largely on the grounds that it was proving and would prove politically and electorally toxic for the Tory party. The bill would hand £60bn of NHS funds to GP-led local groups of doctors to spend on patients' treatments and open the door to more private provision of NHS services.
• Labour's Andy Burnham offered to sit down with the government and work on passing legislation on GP-led commissioning - if the coalition scraps the rest of the bill (see 10.29pm). The bill is currently at report stage in the House of Lords. We will continue to cover its progress next week here on the NHS reforms live blog.
4.32pm: Andrew Lansley told journalists today it was not time for him to resign as health secretary, the Press Association news agency reports.4.32pm: Andrew Lansley told journalists today it was not time for him to resign as health secretary, the Press Association news agency reports.
Asked if it was time he stepped down to save the plans, Lansley said:Asked if it was time he stepped down to save the plans, Lansley said:
No, it is not. Because actually we as a government have committed to supporting the NHS. This legislation has been supported by the House of Commons, by the House of Lords.No, it is not. Because actually we as a government have committed to supporting the NHS. This legislation has been supported by the House of Commons, by the House of Lords.
Lansley was speaking after his speech to surgeons in Edinburgh. He added:Lansley was speaking after his speech to surgeons in Edinburgh. He added:
It is not about the bill as such, it is about what the bill enables the NHS to achieve in the future. That is not about me, that is about us as a government. It is because the NHS matters so much, because we believe in the values of the NHS, we have to be prepared to reform.It is not about the bill as such, it is about what the bill enables the NHS to achieve in the future. That is not about me, that is about us as a government. It is because the NHS matters so much, because we believe in the values of the NHS, we have to be prepared to reform.
4.23pm: TubawayArmy posts an interesting question below the line:4.23pm: TubawayArmy posts an interesting question below the line:
Out of interest, doe anyone know how many of those made redundant to date (from PCT's etc) have been employed elsewhere in the NHS ??? I know from a friend who is a manager at Derby, there have been several instances.Out of interest, doe anyone know how many of those made redundant to date (from PCT's etc) have been employed elsewhere in the NHS ??? I know from a friend who is a manager at Derby, there have been several instances.
And ShawIan makes this point about quality assurance:And ShawIan makes this point about quality assurance:
This bill doesn't just fragment commissioning across a large number of CCGs (remember the number of PCTs were halved in 2007 to make them more effective!) it also fragments responsibility for quality assurance, patient safety and clinical governance across a number of CCGs as they are far too small to do it themselves. This will necessitate high levels of collaboration and co-ordination and management support. The risks of people dropping through the gaps are high. I'm not surprised Lansley has refused to release the risk analysis. There WAS a need for greater clinical engagement with the PCT, but that could have been done easily by changing the composition of the boards, we didn't need this reorganisation and we didn't need to put patients at risk. Look at the report on Mid-Staffs and look at the current situation of trusts being rushed to FT status and fragmented commissioning - the parallels are there for all to see ...This bill doesn't just fragment commissioning across a large number of CCGs (remember the number of PCTs were halved in 2007 to make them more effective!) it also fragments responsibility for quality assurance, patient safety and clinical governance across a number of CCGs as they are far too small to do it themselves. This will necessitate high levels of collaboration and co-ordination and management support. The risks of people dropping through the gaps are high. I'm not surprised Lansley has refused to release the risk analysis. There WAS a need for greater clinical engagement with the PCT, but that could have been done easily by changing the composition of the boards, we didn't need this reorganisation and we didn't need to put patients at risk. Look at the report on Mid-Staffs and look at the current situation of trusts being rushed to FT status and fragmented commissioning - the parallels are there for all to see ...
3.38pm: More than £600m could be spent on NHS redundancies in one year as a result of the government's controversial reforms, figures show. Estimates from the Department of Health show £616.6m accounted for in possible redundancy costs for 2011-12, the Press Association reports.3.38pm: More than £600m could be spent on NHS redundancies in one year as a result of the government's controversial reforms, figures show. Estimates from the Department of Health show £616.6m accounted for in possible redundancy costs for 2011-12, the Press Association reports.
The health service has already made £195m of redundancy payments in 2010-11, all of which have been attributed to "the modernisation" of the NHS, documents show. Total redundancy costs as a result of the health and social care bill, including cash already spent in 2010-11, are expected to be between £632m and £989m, with a government "best estimate" of £810m.The health service has already made £195m of redundancy payments in 2010-11, all of which have been attributed to "the modernisation" of the NHS, documents show. Total redundancy costs as a result of the health and social care bill, including cash already spent in 2010-11, are expected to be between £632m and £989m, with a government "best estimate" of £810m.
Predicted job losses in the NHS - from April 2011 onwards - as a direct result of the reforms, which are still going through parliament, is 9,100 to 16,800, PA reports.Predicted job losses in the NHS - from April 2011 onwards - as a direct result of the reforms, which are still going through parliament, is 9,100 to 16,800, PA reports.
3.24pm: Ladbrokes has made Andrew Lansley the 2/1 favourite for the next cabinet exit, reports PoliticalBetting.com.3.24pm: Ladbrokes has made Andrew Lansley the 2/1 favourite for the next cabinet exit, reports PoliticalBetting.com.
3.17pm: The Guido Fawkes blog quotes "friends of Andrew Lansley" as briefing against Tim Montgomerie, the editor of ConservativeHome, in these terms:3.17pm: The Guido Fawkes blog quotes "friends of Andrew Lansley" as briefing against Tim Montgomerie, the editor of ConservativeHome, in these terms:
Tim's sole achievement in politics was to be chief of staff to the most unpopular leader in Conservative history [Iain Duncan Smith], so forgive us if we don't take any lessons from him. He clearly wants to take the party back to the bad old days of constant infighting and no policy. He should stick to talking about gay marriage and leave serious issues like the NHS to the grown ups.Tim's sole achievement in politics was to be chief of staff to the most unpopular leader in Conservative history [Iain Duncan Smith], so forgive us if we don't take any lessons from him. He clearly wants to take the party back to the bad old days of constant infighting and no policy. He should stick to talking about gay marriage and leave serious issues like the NHS to the grown ups.
2.58pm: Andrew Lansley has been speaking in Edinburgh, where he was met with protests (see 1.59pm). The Press Association reports that he used his speech to the Royal College of Surgeons to restate the case for his reforms, which would only apply to England.2.58pm: Andrew Lansley has been speaking in Edinburgh, where he was met with protests (see 1.59pm). The Press Association reports that he used his speech to the Royal College of Surgeons to restate the case for his reforms, which would only apply to England.
Lansley said that Joseph Lister, who pioneered antiseptic surgery, would approve of his handing "control" to clinicians. Referring to the protest outside the hall, he told the audience:Lansley said that Joseph Lister, who pioneered antiseptic surgery, would approve of his handing "control" to clinicians. Referring to the protest outside the hall, he told the audience:
As some of you may have heard, we're making a few changes south of the border. Giving patients more control of their own healthcare will embody the principle of shared decision making.As some of you may have heard, we're making a few changes south of the border. Giving patients more control of their own healthcare will embody the principle of shared decision making.
We're putting clinicians in charge, free from burdensome top-down, process-driven controls. That principle of clinical leadership, putting doctors, nurses and indeed surgeons in charge of the provision of health services, I think that's something Joseph Lister would have been very much in favour of.We're putting clinicians in charge, free from burdensome top-down, process-driven controls. That principle of clinical leadership, putting doctors, nurses and indeed surgeons in charge of the provision of health services, I think that's something Joseph Lister would have been very much in favour of.
I do believe we are about to see a huge upward shift in quality in the NHS in England.I do believe we are about to see a huge upward shift in quality in the NHS in England.
Lansley said his reasons for trying to modernise the health service were "very simple".Lansley said his reasons for trying to modernise the health service were "very simple".
I want patients in the NHS to enjoy outcomes, results, that are consistently among the very best available anywhere in the world.I want patients in the NHS to enjoy outcomes, results, that are consistently among the very best available anywhere in the world.
Outside, protester Ledys Sanjuan, a 22-year-old Edinburgh University student, said:Outside, protester Ledys Sanjuan, a 22-year-old Edinburgh University student, said:
I'm protesting because he is seeking to privatise the NHS, which I think will have a really bad effect. Also, like we saw with tuition fees in England, it could have a knock-on effect in Scotland.I'm protesting because he is seeking to privatise the NHS, which I think will have a really bad effect. Also, like we saw with tuition fees in England, it could have a knock-on effect in Scotland.
2.51pm: At the Spectator's Coffee House blog, Peter Hoskin says it is looking more and more likely that David Cameron will drop the health bill.2.51pm: At the Spectator's Coffee House blog, Peter Hoskin says it is looking more and more likely that David Cameron will drop the health bill.
The NHS was meant to be the bedrock on which the Cameroons' modernisation programme was founded, but their approach to it is now more self-harming than anything else. For all the reassurances about real terms spending increases, for all the posters, the Tories still lag Labour on the issue by eight points, and that gap is likely to increase.The NHS was meant to be the bedrock on which the Cameroons' modernisation programme was founded, but their approach to it is now more self-harming than anything else. For all the reassurances about real terms spending increases, for all the posters, the Tories still lag Labour on the issue by eight points, and that gap is likely to increase.
2.11pm: Lately ministers have been attempting to downplay the BMA's opposition to the health bill's measures by referring to it as a "trade union" (it is, but the government believes drawing attention to that will discredit it) and by pointing out, as Simon Burns did this morning, that it opposed the setting up of the NHS in 1948.2.11pm: Lately ministers have been attempting to downplay the BMA's opposition to the health bill's measures by referring to it as a "trade union" (it is, but the government believes drawing attention to that will discredit it) and by pointing out, as Simon Burns did this morning, that it opposed the setting up of the NHS in 1948.
My colleague Ben Goldacre, who writes the Bad Science column, responds to that argument on his blog:My colleague Ben Goldacre, who writes the Bad Science column, responds to that argument on his blog:
1. This was another world, SEVENTY years ago. An era when some in the royal family supported the Nazis.1. This was another world, SEVENTY years ago. An era when some in the royal family supported the Nazis.
2. Doctors in the 1890s, 1920s went into a profession of freelancers. Doctors today sign up at age 17 for a lifetime in the NHS, and have done for generations.2. Doctors in the 1890s, 1920s went into a profession of freelancers. Doctors today sign up at age 17 for a lifetime in the NHS, and have done for generations.
3. Imagine nationalising the work of all accountants, or all lawyers, right now, today. Good luck getting them on board with that plan, ever.3. Imagine nationalising the work of all accountants, or all lawyers, right now, today. Good luck getting them on board with that plan, ever.
4. And yet by 1948, 90% of doctors had signed on for the NHS.4. And yet by 1948, 90% of doctors had signed on for the NHS.
5. In 1940s, the Tories voted against the NHS. Not once, but on the 2nd, and 3rd readings of the bill. The Tories FULLY opposed the NHS.5. In 1940s, the Tories voted against the NHS. Not once, but on the 2nd, and 3rd readings of the bill. The Tories FULLY opposed the NHS.
The BMA gave its own view on this issue in 2009:The BMA gave its own view on this issue in 2009:
The initiative for a national health service came largely from the British Medical Association and the doctors … The initial proposals put forward from the coalition government [of 1940-45] were for a comprehensive medical service based on the employment of doctors as salaried officers. The medical profession believed that such a proposal regarding doctors as salaried officers would be contrary to the public interest and would be unacceptable to the great majority of the profession.The initiative for a national health service came largely from the British Medical Association and the doctors … The initial proposals put forward from the coalition government [of 1940-45] were for a comprehensive medical service based on the employment of doctors as salaried officers. The medical profession believed that such a proposal regarding doctors as salaried officers would be contrary to the public interest and would be unacceptable to the great majority of the profession.
It was the principle of the salaried service which was opposed. During the course of negotiations with the governments (Conservative and then Labour) on the terms of the service being imposed upon them, the medical profession did not withdraw their support for a general medical service for the nation.It was the principle of the salaried service which was opposed. During the course of negotiations with the governments (Conservative and then Labour) on the terms of the service being imposed upon them, the medical profession did not withdraw their support for a general medical service for the nation.
The BMA's opposition in the 1940s - contrary to mythology - was not related to the principle of a national health service, but to the concept of general practitioners being in a salaried service.The BMA's opposition in the 1940s - contrary to mythology - was not related to the principle of a national health service, but to the concept of general practitioners being in a salaried service.
1.59pm: The Press Association reports that protesters opposed to the health bill demonstrated outside a lecture Andrew Lansley was delivering in Scotland this afternoon.1.59pm: The Press Association reports that protesters opposed to the health bill demonstrated outside a lecture Andrew Lansley was delivering in Scotland this afternoon.
Lansley has no control over the health service in Scotland.Lansley has no control over the health service in Scotland.
1.56pm: My colleague Denis Campbell, the Guardian's health correspondent, writes that a consensus is emerging about exactly which elements of Lansley's radical reorganisation would or would not survive the dropping, or huge scaling back, of the heath and social care bill.1.56pm: My colleague Denis Campbell, the Guardian's health correspondent, writes that a consensus is emerging about exactly which elements of Lansley's radical reorganisation would or would not survive the dropping, or huge scaling back, of the heath and social care bill.
Denis points out that the 150 NHS primary care trusts in England have already been merged into 50 PCT clusters, and the nine strategic health authorities have been transformed into four mega-SHAs.Denis points out that the 150 NHS primary care trusts in England have already been merged into 50 PCT clusters, and the nine strategic health authorities have been transformed into four mega-SHAs.
Under the bill they are all due to be abolished in April 2013, with their functions taken over by, respectively, GP-led local groups of doctors called clinical commissioning groups (CCGs) and the NHS's new National Commissioning Board (NCB). There is already a fledgling CCG in 95% of England, and the NCB – which is intended to fulfil the government's promise of making the NHS more independent of ministers – already exists, albeit only in shadow form, although many of its key positions have already been filled.Under the bill they are all due to be abolished in April 2013, with their functions taken over by, respectively, GP-led local groups of doctors called clinical commissioning groups (CCGs) and the NHS's new National Commissioning Board (NCB). There is already a fledgling CCG in 95% of England, and the NCB – which is intended to fulfil the government's promise of making the NHS more independent of ministers – already exists, albeit only in shadow form, although many of its key positions have already been filled.
Clinical commissioning - handing CCGs £60bn of NHS funds to spend as they see fit on patients' treatments - is supported even by those who oppose the bill, and will go ahead with or without it, Denis predicts. This could be done by the PCT clusters.Clinical commissioning - handing CCGs £60bn of NHS funds to spend as they see fit on patients' treatments - is supported even by those who oppose the bill, and will go ahead with or without it, Denis predicts. This could be done by the PCT clusters.
The future of the NCB is more problematic, Denis reports. And he adds:The future of the NCB is more problematic, Denis reports. And he adds:
If the bill goes then the planned expansion of competition, transformation of Monitor into an economic regulator for the NHS and all the other "free market" moves that have caused the most concern of all the bill's proposals would go too. Few would lament their passing.If the bill goes then the planned expansion of competition, transformation of Monitor into an economic regulator for the NHS and all the other "free market" moves that have caused the most concern of all the bill's proposals would go too. Few would lament their passing.
1.33pm: The health and social care bill is currently at report stage in the House of Lords.1.33pm: The health and social care bill is currently at report stage in the House of Lords.
This is a line-by-line examination of the bill by peers. You can read the whole bill here or download a pdf of it here. It's 460 pages long.This is a line-by-line examination of the bill by peers. You can read the whole bill here or download a pdf of it here. It's 460 pages long.
The next stage is consolidation of amendments between the Commons and Lords - if the bill gets that far, it will then go for royal assent before becoming law.The next stage is consolidation of amendments between the Commons and Lords - if the bill gets that far, it will then go for royal assent before becoming law.
1.26pm: In the comments below, some of you have been wondering what the Lib Dems think of all this. At the Liberal Democrat Voice website, Prateek Buch argues "that with so many changes to services already underway, they [the government] should withdraw the bulk of the bill and allow the NHS to focus on delivering a first-class service at a time of severe budgetary constraint as set out in the coalition agreement. There's little doubt this would be a better outcome than pressing ahead with legislation that now virtually nobody thinks is needed."1.26pm: In the comments below, some of you have been wondering what the Lib Dems think of all this. At the Liberal Democrat Voice website, Prateek Buch argues "that with so many changes to services already underway, they [the government] should withdraw the bulk of the bill and allow the NHS to focus on delivering a first-class service at a time of severe budgetary constraint as set out in the coalition agreement. There's little doubt this would be a better outcome than pressing ahead with legislation that now virtually nobody thinks is needed."
Most of the comments beneath the piece are hostile towards the bill. Peebee writes:Most of the comments beneath the piece are hostile towards the bill. Peebee writes:
Now is the time for Clegg to act, show leadership and bring the party together – if this isn't a red line issue I don't know if there ever will be one. If he doesn't and the bill goes ahead he is saddled with explaining why the Lib Dems supported a measure that even senior Conservatives have grave misgivings about (you don't get an article like that on ConservativeHome without those senior figures giving the green light). If he doesn't and the bill gets dropped he will be left to explain why the Lib Dems under his leadership supported a measure all along that eventually is exposed as worthless.Now is the time for Clegg to act, show leadership and bring the party together – if this isn't a red line issue I don't know if there ever will be one. If he doesn't and the bill goes ahead he is saddled with explaining why the Lib Dems supported a measure that even senior Conservatives have grave misgivings about (you don't get an article like that on ConservativeHome without those senior figures giving the green light). If he doesn't and the bill gets dropped he will be left to explain why the Lib Dems under his leadership supported a measure all along that eventually is exposed as worthless.
12.55pm: Tory junior health minister Simon Burns has just been speaking to BBC News. He was asked about the level of professional opposition to the bill, and responded:12.55pm: Tory junior health minister Simon Burns has just been speaking to BBC News. He was asked about the level of professional opposition to the bill, and responded:
You haven't mentioned those organisations like the Royal College of Gynaecologists and the Family Doctors' Association which support the legislation. Of course, if you take the BMA, who seem to have contradictory views in that their special general meeting last summer they voted in support of GPs commissioning care, and of course they were an organisation that was against the whole concept of the National Health Service when it was first put forward by Nye Bevan [in the 1940s].You haven't mentioned those organisations like the Royal College of Gynaecologists and the Family Doctors' Association which support the legislation. Of course, if you take the BMA, who seem to have contradictory views in that their special general meeting last summer they voted in support of GPs commissioning care, and of course they were an organisation that was against the whole concept of the National Health Service when it was first put forward by Nye Bevan [in the 1940s].
The presenter later listed groups opposing the bill:The presenter later listed groups opposing the bill:
• The Faculty of Public Health
• The Royal College of GPs
• The British Medical Association
• The Royal College of Nursing
• The Royal College of Midwives
• The Chartered Society of Physiotherapy
• The Royal College of Opthomologists		• The Faculty of Public Health
• The Royal College of GPs
• The British Medical Association
• The Royal College of Nursing
• The Royal College of Midwives
• The Chartered Society of Physiotherapy
• The Royal College of Opthomologists
and added five or six more after that.and added five or six more after that.
Burns responded:Burns responded:
The list that you have read out, if you look at the number of those responses to the white paper, to the recommendations to improve and strengthen the bill that were made by the independent Future Forum last year, which the government accepted and were welcomed by those bodies, if you look at their responses to the white paper as well, given that the bill covers a very wide range of issues within the NHS, there were some issues that they were supportive of, for example, the BMA are very supportive, or were, of GP commissioning.The list that you have read out, if you look at the number of those responses to the white paper, to the recommendations to improve and strengthen the bill that were made by the independent Future Forum last year, which the government accepted and were welcomed by those bodies, if you look at their responses to the white paper as well, given that the bill covers a very wide range of issues within the NHS, there were some issues that they were supportive of, for example, the BMA are very supportive, or were, of GP commissioning.
On the ministers who had reportedly spoken to ConservativeHome, he said:On the ministers who had reportedly spoken to ConservativeHome, he said:
They are all unnamed. I regard it as tittle-tattle … I don't know who he has allegedly spoken to so in that respect it is tittle-tattle.They are all unnamed. I regard it as tittle-tattle … I don't know who he has allegedly spoken to so in that respect it is tittle-tattle.
Burns went on to give a long answer that reminded me of this story by the Times's Sam Coates (£) about the speech written by former Guardian columnist and now No 10 speechwriter Julian Glover for Andrew Lansley. According to Coates, the original draft personalised Lansley's connections to the health service in an effective way, but Lansley apparently added jargon-filled notes such as: "Not structural integration but integration around families and children. Marmot (universal proportionalism) — early intervention."Burns went on to give a long answer that reminded me of this story by the Times's Sam Coates (£) about the speech written by former Guardian columnist and now No 10 speechwriter Julian Glover for Andrew Lansley. According to Coates, the original draft personalised Lansley's connections to the health service in an effective way, but Lansley apparently added jargon-filled notes such as: "Not structural integration but integration around families and children. Marmot (universal proportionalism) — early intervention."
Burns's answer wasn't that bad. But he said:Burns's answer wasn't that bad. But he said:
From what I see within the parliamentary party and with my conversations with ministers they are very fully supportive because they understand the need for the NHS to modernise, to make sure that patients [are] at the centre of decision-making about their health, that we cut down on bureaucracy and have more doctors and midwives within the NHS and that we save money by cutting back on inefficient delivery of care and inefficiencies in bureaucracy and management, so that the savings, which is £4.5bn between now and the next election, can be reinvested in healthcare.From what I see within the parliamentary party and with my conversations with ministers they are very fully supportive because they understand the need for the NHS to modernise, to make sure that patients [are] at the centre of decision-making about their health, that we cut down on bureaucracy and have more doctors and midwives within the NHS and that we save money by cutting back on inefficient delivery of care and inefficiencies in bureaucracy and management, so that the savings, which is £4.5bn between now and the next election, can be reinvested in healthcare.
Burns was at least able to claim the moral high ground when asked about Tim Montgomerie's argument that the bill should be scrapped because of the political damage it is doing to the Tory party.Burns was at least able to claim the moral high ground when asked about Tim Montgomerie's argument that the bill should be scrapped because of the political damage it is doing to the Tory party.
I'm afraid you cannot look at it in raw political terms. The future of the NHS and its improvement is far more important than just looking at it in a narrow political term. What we have to look at: what is best for patients, what is best for reducing bureaucracy, what is best for maximising the money available to improve and enhance the NHS. You cannot, and it would be irresponsible to look at it in the narrow terms of party gain or party management. That is not the right way forward. The NHS is far too important to play party politics with it.I'm afraid you cannot look at it in raw political terms. The future of the NHS and its improvement is far more important than just looking at it in a narrow political term. What we have to look at: what is best for patients, what is best for reducing bureaucracy, what is best for maximising the money available to improve and enhance the NHS. You cannot, and it would be irresponsible to look at it in the narrow terms of party gain or party management. That is not the right way forward. The NHS is far too important to play party politics with it.
12.20pm: On the Guardian's Healthcare Network, one of our regular contributors, Pollyanna Perkins, writes about the impact of the reforms on NHS staff:12.20pm: On the Guardian's Healthcare Network, one of our regular contributors, Pollyanna Perkins, writes about the impact of the reforms on NHS staff:
They are worried about their jobs and fed up with being told they are hopeless and irrelevant by ministers. They are also unsure as to where they can transfer their skills, especially with local government unable to recruit, and they are frustrated their experience and knowledge will be lost to the health economy.They are worried about their jobs and fed up with being told they are hopeless and irrelevant by ministers. They are also unsure as to where they can transfer their skills, especially with local government unable to recruit, and they are frustrated their experience and knowledge will be lost to the health economy.
No one in the NHS expects a job for life but they do expect to be treated with dignity and respect when changes are being implemented. They do not wished to be used as a convenient target for politicians and the media to make their case for change in a simplistic way.No one in the NHS expects a job for life but they do expect to be treated with dignity and respect when changes are being implemented. They do not wished to be used as a convenient target for politicians and the media to make their case for change in a simplistic way.
12.18pm: A 38 Degrees online petition against the health bill has reached 500,000 signatures.12.18pm: A 38 Degrees online petition against the health bill has reached 500,000 signatures.
12.06pm: Who are the three Tory cabinet ministers who have been speaking out against the health bill to ConservativeHome's Tim Montgomerie. My colleague Michael White says this is a game everyone can play, posting the cabinet list to jog your memory. He runs through his own chief suspects:12.06pm: Who are the three Tory cabinet ministers who have been speaking out against the health bill to ConservativeHome's Tim Montgomerie. My colleague Michael White says this is a game everyone can play, posting the cabinet list to jog your memory. He runs through his own chief suspects:
Eric Pickles (local government) is the cabinet's token working-class member, thought to be on his way out and a man of strong and confident views; a populist, too. I'd put him on my shortlist of suspects for Hercule Poirot to take DNA samples from. IDS? You betcha. Owen Paterson, the Northern Ireland secretary? … He is confident and has views too …Eric Pickles (local government) is the cabinet's token working-class member, thought to be on his way out and a man of strong and confident views; a populist, too. I'd put him on my shortlist of suspects for Hercule Poirot to take DNA samples from. IDS? You betcha. Owen Paterson, the Northern Ireland secretary? … He is confident and has views too …
My last suspect is Michael Gove. Yes, I know he's a weekend chum of the PM, but he's also confident – too confident, some would say – and a bit mouthy. He's also shown how to push forward a radical agenda in the schools system without arousing Lansley-esque rage on the same scale.My last suspect is Michael Gove. Yes, I know he's a weekend chum of the PM, but he's also confident – too confident, some would say – and a bit mouthy. He's also shown how to push forward a radical agenda in the schools system without arousing Lansley-esque rage on the same scale.
Mike thinks Cameron will not back down on the bill. "It would signal disarray and weakness, undermine coalition cohesion, encourage rebellion and insubordination in the ranks. At this stage it would also cause all sorts of legal and political problems in the NHS since - quite improperly – the primary care trust network has already collapsed in many areas and GP-led commissioning a de facto reality in the making."Mike thinks Cameron will not back down on the bill. "It would signal disarray and weakness, undermine coalition cohesion, encourage rebellion and insubordination in the ranks. At this stage it would also cause all sorts of legal and political problems in the NHS since - quite improperly – the primary care trust network has already collapsed in many areas and GP-led commissioning a de facto reality in the making."
11.35am: As my colleagues Andrew Sparrow, Patrick Wintour and Juliette Jowit write, ConservativeHome is not officially linked to the Conservative party, but it is read by thousands of activists, whose views it broadly represents, and, although it does criticise government policy, it is generally supportive and not given to gratuitous attacks on the party leadership. The comments beneath Warsi's article so far seem split between those who back the bill, those who want to drop it, whether because of its content or the political damage it is inflicting, and those who feel Tim Montgomerie has caused greater damage to the Tory party by coming out against it. Two comments in quick succession suggest the party's divisions on the issue:11.35am: As my colleagues Andrew Sparrow, Patrick Wintour and Juliette Jowit write, ConservativeHome is not officially linked to the Conservative party, but it is read by thousands of activists, whose views it broadly represents, and, although it does criticise government policy, it is generally supportive and not given to gratuitous attacks on the party leadership. The comments beneath Warsi's article so far seem split between those who back the bill, those who want to drop it, whether because of its content or the political damage it is inflicting, and those who feel Tim Montgomerie has caused greater damage to the Tory party by coming out against it. Two comments in quick succession suggest the party's divisions on the issue:
Sack the Tory ministers who are briefing against the government.Sack the Tory ministers who are briefing against the government.
Those three Tory ministers should be given knighthoods for services to the British people.Those three Tory ministers should be given knighthoods for services to the British people.
Commenter Cleethorpes Rock summarises (accurately, I think) the public's view of the bill. The perception is that it:Commenter Cleethorpes Rock summarises (accurately, I think) the public's view of the bill. The perception is that it:
1. Is a disruptive re-organisation1. Is a disruptive re-organisation
2. Messes around hard-working NHS staff2. Messes around hard-working NHS staff
3. Has something to do with "privatisation"3. Has something to do with "privatisation"
4. Costs a load of money4. Costs a load of money
11.17am: Warsi's article was entitled - perhaps in a slightly inflammatory fashion - "As Conservatives it is our duty to support the NHS bill". In response author John O'Donoghue tweets:11.17am: Warsi's article was entitled - perhaps in a slightly inflammatory fashion - "As Conservatives it is our duty to support the NHS bill". In response author John O'Donoghue tweets:
No Baroness W it's not the duty of Conservatives to support the NHS Bill; it's the duty of Conservatives to do what's best for the country.No Baroness W it's not the duty of Conservatives to support the NHS Bill; it's the duty of Conservatives to do what's best for the country.
— John O'Donoghue (@JOD45) February 10, 2012— John O'Donoghue (@JOD45) February 10, 2012
And on his blog journalist Iain Martin has some ideas on how the prime minister could get out of the tricky situation he finds himself in :And on his blog journalist Iain Martin has some ideas on how the prime minister could get out of the tricky situation he finds himself in :
Cameron now has to work out how to extricate himself. Actually, I don't think it's quite as difficult as it appears in the middle of the current media maelstrom. If he does decide to do it he would need a new health secretary. With that person he would call a press conference to say that he had listened to the medical profession and decided to take his medicine. The bill would be dropped and a helpline would be set up for confused doctors. Cameron could say that much of the better parts of the bill, on GP commissioning etc, could be implemented without legislation ... There would be a "huge row", but it would subside after a few days.Cameron now has to work out how to extricate himself. Actually, I don't think it's quite as difficult as it appears in the middle of the current media maelstrom. If he does decide to do it he would need a new health secretary. With that person he would call a press conference to say that he had listened to the medical profession and decided to take his medicine. The bill would be dropped and a helpline would be set up for confused doctors. Cameron could say that much of the better parts of the bill, on GP commissioning etc, could be implemented without legislation ... There would be a "huge row", but it would subside after a few days.
10.49am: Baroness Warsi, the Tory chair, has responded to the ConservativeHome post, in defence of the bill. Conservatism has always been about handing power to the individual, she argues, and this is what the bill will do (cutting out £4.5bn in bureaucracy in the process). She goes on:10.49am: Baroness Warsi, the Tory chair, has responded to the ConservativeHome post, in defence of the bill. Conservatism has always been about handing power to the individual, she argues, and this is what the bill will do (cutting out £4.5bn in bureaucracy in the process). She goes on:
The simple truth is that the bill hands power to the frontline, and all of the arguments against it simply play to the vested interests of those who have something to lose. In fact, the arguments against it are incoherent when put together in any case.The simple truth is that the bill hands power to the frontline, and all of the arguments against it simply play to the vested interests of those who have something to lose. In fact, the arguments against it are incoherent when put together in any case.
The first argument against the bill is that we don't need legislation. Those who articulate this argument all of a sudden should be asked why, then, do they oppose it?The first argument against the bill is that we don't need legislation. Those who articulate this argument all of a sudden should be asked why, then, do they oppose it?
The second argument against the bill is that it introduces a free market free for all. This is inconsistent with the first argument, and indeed with the bill. It is a myth that the bill introduces a free market – rather it ensure the NHS is a properly regulated sector, which gives patients power while protecting patients' interests.The second argument against the bill is that it introduces a free market free for all. This is inconsistent with the first argument, and indeed with the bill. It is a myth that the bill introduces a free market – rather it ensure the NHS is a properly regulated sector, which gives patients power while protecting patients' interests.
The final argument is the most threadbare. People claim that the NHS needs to deliver £20bn of efficiencies over the next few years, and that this bill is a distraction. That is a cruel deceit. The bill is needed to ensure that the NHS is more efficient. It is needed precisely to avoid a situation happening in the future where a Labour government allows a £20bn productivity black hole in the NHS from opening up.The final argument is the most threadbare. People claim that the NHS needs to deliver £20bn of efficiencies over the next few years, and that this bill is a distraction. That is a cruel deceit. The bill is needed to ensure that the NHS is more efficient. It is needed precisely to avoid a situation happening in the future where a Labour government allows a £20bn productivity black hole in the NHS from opening up.
10.29am: Andy Burnham (left), the shadow health secretary, has been calling for the bill to be scrapped in its entirety today. But he did say that if the government did that he would be willing to sit down with them and introduce GP-led commissioning on a cross-party basis.10.29am: Andy Burnham (left), the shadow health secretary, has been calling for the bill to be scrapped in its entirety today. But he did say that if the government did that he would be willing to sit down with them and introduce GP-led commissioning on a cross-party basis.
The Press Association reports Burnham saying:The Press Association reports Burnham saying:
We already know that the prime minister isn't listening to doctors and nurses. But it's a shock to find out that even senior members of his own cabinet have to take to a Conservative website to get through to him about the damage he is doing to the NHS.We already know that the prime minister isn't listening to doctors and nurses. But it's a shock to find out that even senior members of his own cabinet have to take to a Conservative website to get through to him about the damage he is doing to the NHS.
It couldn't be clearer: this is an out-of-touch prime minister who is putting his political pride before the best interests of the NHS. Only this week, he insisted he will try to ram a bill through parliament which no one wants and which will do irreparable harm to our health service. David Cameron promised to protect the NHS but every day he digs in behind his bill, he damages it further. He is out of touch with the people of Britain. He is betraying the NHS. He must drop this bill.It couldn't be clearer: this is an out-of-touch prime minister who is putting his political pride before the best interests of the NHS. Only this week, he insisted he will try to ram a bill through parliament which no one wants and which will do irreparable harm to our health service. David Cameron promised to protect the NHS but every day he digs in behind his bill, he damages it further. He is out of touch with the people of Britain. He is betraying the NHS. He must drop this bill.
On Sky News he expanded upon these comments, saying it was "the wrong time to reorganise the NHS".On Sky News he expanded upon these comments, saying it was "the wrong time to reorganise the NHS".
We've said that from the very beginning. The NHS is facing the biggest financial challenge in its history. It needs to focus everything on that challenge because it's a huge challenge that's facing. The government did the worst possible thing which was to launch the biggest ever reorganisation.We've said that from the very beginning. The NHS is facing the biggest financial challenge in its history. It needs to focus everything on that challenge because it's a huge challenge that's facing. The government did the worst possible thing which was to launch the biggest ever reorganisation.
Asked what kind of reforms the health service actually needed, Burnham said:Asked what kind of reforms the health service actually needed, Burnham said:
The change the NHS needs is change to services on the ground. So fewer patients treated in hospital, more patient treated in their local community or even at home. That's the kind of change the NHS needs to make it fit for the future. The problem with this back-office is that it wastes billions of pounds on strictures and redundancies and consultants' fees when all of our attention should be on that service change to help the NHS get ready for the future. That is what is so catastrophic with this unnecessary bill.The change the NHS needs is change to services on the ground. So fewer patients treated in hospital, more patient treated in their local community or even at home. That's the kind of change the NHS needs to make it fit for the future. The problem with this back-office is that it wastes billions of pounds on strictures and redundancies and consultants' fees when all of our attention should be on that service change to help the NHS get ready for the future. That is what is so catastrophic with this unnecessary bill.
He was asked whether it would be better to amend the bill now than scrap it.He was asked whether it would be better to amend the bill now than scrap it.
This bill is unamendable. It's three times as big as the bill that created the National Health Service. We've already had 2,000 government amendments. It's a complete and unmitigated mess. And it's not possible to amend this bill; it would just cause confusion to people in the health service.This bill is unamendable. It's three times as big as the bill that created the National Health Service. We've already had 2,000 government amendments. It's a complete and unmitigated mess. And it's not possible to amend this bill; it would just cause confusion to people in the health service.
I've not just said 'drop the bill'. I've said if they drop the bill I will work with them to introduce GP-led commissioning. Now, ConservativeHome are saying today in their article that perhaps the prime minister should sit round the table with me and others in the Labour party to agree a cross-party way forward. Now, I [would] accept that invitation. I would play my part to put the NHS first and bring stability to the service but on condition that the entire bill is dropped.I've not just said 'drop the bill'. I've said if they drop the bill I will work with them to introduce GP-led commissioning. Now, ConservativeHome are saying today in their article that perhaps the prime minister should sit round the table with me and others in the Labour party to agree a cross-party way forward. Now, I [would] accept that invitation. I would play my part to put the NHS first and bring stability to the service but on condition that the entire bill is dropped.
10.15am: The government's controversial reorganisation of the NHS has run into fresh trouble today after the Conservative party's most widely read and influential website urged David Cameron to scrap large chunks of the legislation and replace Andrew Lansley as health secretary.10.15am: The government's controversial reorganisation of the NHS has run into fresh trouble today after the Conservative party's most widely read and influential website urged David Cameron to scrap large chunks of the legislation and replace Andrew Lansley as health secretary.
Tim Montgomerie, the editor of ConservativeHome, said in a post published this morning that Lansley, the health secretary, had failed to win public support for the legislation and that, if the Tories did not back down, every problem with the NHS over the next three years would be blamed on the bill.Tim Montgomerie, the editor of ConservativeHome, said in a post published this morning that Lansley, the health secretary, had failed to win public support for the legislation and that, if the Tories did not back down, every problem with the NHS over the next three years would be blamed on the bill.
Montgomerie said he was encouraged to speak out by three Tory cabinet ministers who felt negatively about the bill. Montgomerie wrote:Montgomerie said he was encouraged to speak out by three Tory cabinet ministers who felt negatively about the bill. Montgomerie wrote:
One was insistent the bill must be dropped. Another said Andrew Lansley must be replaced. Another likened the NHS reforms to the poll tax.One was insistent the bill must be dropped. Another said Andrew Lansley must be replaced. Another likened the NHS reforms to the poll tax.
To add to the government's problems regarding the controversial bill - which hands £60bn of NHS funds to GP-led local groups of doctors to spend on patients' treatments and opens the door to more private provision of NHS services - it was revealed that Lib Dem activists want to call a vote on scrapping the bill at the Lib Dem spring conference next month.To add to the government's problems regarding the controversial bill - which hands £60bn of NHS funds to GP-led local groups of doctors to spend on patients' treatments and opens the door to more private provision of NHS services - it was revealed that Lib Dem activists want to call a vote on scrapping the bill at the Lib Dem spring conference next month.
The bill is currently going through the House of Lords and my colleague Tom Clark has written a great piece explaining what the legislation proposes and how that differs from the government's original plans. (There is also an interactive version here.) As Tom explains, some of the changes proposed by the bill, such as PCTs merging into "clusters" as a prelude to abolition, have already begun.The bill is currently going through the House of Lords and my colleague Tom Clark has written a great piece explaining what the legislation proposes and how that differs from the government's original plans. (There is also an interactive version here.) As Tom explains, some of the changes proposed by the bill, such as PCTs merging into "clusters" as a prelude to abolition, have already begun.
Can the NHS bill be unpicked at this stage or are the only choices available to the government pushing it through or scrapping it altogether? Is it too late now to row back on some parts of the bill? Let me know which of the changes you would retain at this stage, which you would get rid of - and what you think the result would be.Can the NHS bill be unpicked at this stage or are the only choices available to the government pushing it through or scrapping it altogether? Is it too late now to row back on some parts of the bill? Let me know which of the changes you would retain at this stage, which you would get rid of - and what you think the result would be.
We will be covering all developments live here throughout the day.We will be covering all developments live here throughout the day.