Labour fails to block Government's controversial NHS reform bill (but is Lansley out?)

Liberal Democrat and Conservative Cabinet Ministers banged the table in jubilation today after they were told the Government’s Health Bill is almost certain to receive royal assent by next Tuesday.

In an open display of partisan celebration – which will infuriate opponents of the Government’s controversial NHS reforms – ministers from both parties joined in the impromptu gesture to mark the passage of the Bill into law.

But privately they concede that the Government has an uphill struggle to successfully implement the reforms in the face of stiff opposition from the medical profession and at a time when the NHS has to find savings of £20 billion over the next four years.

One senior Conservative privately predicted that Andrew Lansley, the Health Secretary, is unlikely to survive in his job beyond the next reshuffle - expected in the Autumn - as David Cameron moves to repair relations with doctors leaders and other health groups who opposed the bill.

“Mr Cameron has the opportunity to wipe the slate clean and start rebuilding relationships with the people who have to implement these reforms,” they said.

“That is impossible with Andrew still in post and frankly I would be amazed if he’s still there by Christmas.”

Among those tipped to take over is the current Culture Secretary Jeremy Hunt – who is seen as an effective communicator which will be vital in attempting to implement the reforms.

Mr Lansley has been repeated criticised for failing to clearly explain the Government’s reforms and alienating groups like GPs who were initially in favour of the plan.

Other possible candidates include David Willetts, Minister of State for Universities and Science, or Stephen Dorrell, a former Health Secretary under John Major who is now chairman of the Health Select Committee.

In a final show of opposition to the Bill Labour today secured a Parliamentary debate calling for the publication of an internal Department of Health risk assessment of the changes before the legislation completed its passage through Parliament.

Shadow health secretary Andy Burnham told MPs: “People outside will struggle to understand how Members of this House could make such momentous decisions without having carefully considered all of the facts and all of the evidence.

“But the truth is, Members will go through the lobbies tonight without knowing the full implications of what it means for the NHS in their constituencies.

“Ministers want this House to back the gamble they are taking with the NHS, without having the courtesy to tell it the odds.”

During Commons question time, Mr Clegg insisted the Government was right to resist calls for the register's publication.

He said: “The reasons why we are withholding its publication are for precisely the same reasons why the Labour government withheld its consent on three occasions.

“Yes, I have seen the risk register and as you know it is a very important tool to allow civil servants to give frank and fearless advice to ministers.

“Champions of freedom of information, like The Independent, have said if we were to publish that, it would inhibit civil servants from providing that frank and fearless advice to ministers in the future.”

Health Secretary Andrew Lansley accused Labour of “political opportunism”, adding civil servants needed “safe space” in which to advise ministers.

He said: “They do not represent a balanced view, they are not a prediction of the future. They set out a worst-case scenario to challenge decision making.

“The point is that we have looked at that balanced view of capturing where the risks and indeed the benefits indeed lie in the impact assessment.

“But publication of the risk register would prejudice the frankness and integrity of the decision-making processes of government and the Government is opposed to their publication.”

Health and Social Care bill: How it has been changed

What the Coalition wanted...

* GPs to take control of £60bn of the NHS budget

* More NHS services to be subject to competition to stimulate innovation and raise standards

* Reduce bureaucracy, cut management and free front-line staff to deliver better care

* An increased role for the private sector

* The NHS to be doing £20bn-worth of extra work for the same money by 2014

* Every professional group to back the changes and pledge to implement them

...the compromises...

* Hospital doctors, nurses and other professionals will now be in the "spending loop"

* Competition will be limited to quality, not price

* More management added due to protests about risks

* All providers to be subject to checks of their suitability to run services

... and what it all means

*Moving services out of hospital into the community will be more difficult

* Less innovation, risk that doctors and managers will stick with the status quo

* Added bureaucracy, which will slow down decision making

* NHS Foundation Trusts will be able to earn up to 49% of income from private sources

* Some trusts will find they are not economically viable and will have to merge or close

* Most professional groups remain bitterly opposed