The government has lost a House of Lords vote on its controversial plans to overhaul the NHS in England. Peers backed an amendment to the Health and Social Care Bill - demanding mental health is made a higher priority - by a margin of four votes. Several other amendments will be debated on Wednesday.
Earlier, David Cameron rebuffed calls to drop the bill entirely, but Labour leader Ed Miliband described it as a "complete disaster". The Health and Social Care Bill, which introduces the biggest shake-up since the founding of the NHS in 1948 and would put GPs in control of much of the NHS budget, returned to the Lords on Wednesday. The legislation is opposed by Labour and has come under fire from several Liberal Democrat and independent peers, meaning it could have a difficult time getting through Parliament. The government has offered more than 100 concessions in an effort to get the bill passed, but opponents say it should be dropped in its entirety. Several peers from across the political spectrum have proposed their own amendments too.
The first of these - demanding that the health secretary ensures that mental health care is treated as importantly as physical health care by the NHS - was put forward by Labour's Lord Patel, and passed by a by 244 votes to 240. Several more amendments - all discussing the powers and responsibilities of the health secretary - will be debated. Some have already been dropped.
Opposition to the bill from medical professionals - including the British Medical Association and the Royal College of Nursing - has led to speculation about Health Secretary Andrew Lansley's position. At prime minister's questions in the House of Commons, Mr Miliband told Mr Cameron: "You know, in your heart of hearts, this is a complete disaster, this bill." Referring to a critical article on the Tory Reform Group website saying: "It comes to something when even the Tories don't trust the Tories on the NHS."
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 Mr 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 Mr 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."
The Tory Reform Group later accused Mr Miliband of a "complete misrepresentation" of its position - as the blog post had been written by an independent contributor and it said it remained a "staunch supporter" of the proposals. As the session was under way in the Commons, the Faculty of Public Health became the latest healthcare body to call for the Bill to be dropped, "in the best interests of everyone's health".
But 54 NHS Trust directors have backed the plan in a letter to the Times, saying there are "sound medical and clinical reasons" for it. On Tuesday Downing Street said Mr Lansley had the prime minister's "full support" - following an anonymous quote in the Times, attributed to a Downing Street source, suggesting the health secretary should be "taken out and shot" over the policy.
It was even suggested that the former Labour Health Secretary Alan Milburn might be given a peerage and then take over from Mr Lansley. But Mr Milburn told BBC Radio 4's World at One there was "fat chance" of that happening. He added: "There might be a demand side. You'll have to ask Number 10 about that. But there certainly isn't a supply side, at least as not as far as I'm concerned." He said the bill showed ministers had "lost their nerve" on NHS reform and that its plans would not help devolution, as had been promised.