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• Today’s agenda • Timeline: NHS reforms • NHS reforms: who are the key players? • NHS reform jargon explained • What are the key issues? 12.29pm: Ed Miliband, the Labour leader, has been out touring the studios to say the coalition has to realise the health and social care bill is “a bad bill”. He was backed, albeit in an unrelated interview, by Spectator editor Fraser Nelson, who said he’d be “delighted if this bill was withdrawn”. Labour’s frontbench spokeswoman Emily Thornberry (above), who in the last election won her seat partly by fighting against a local hospital closure, told the BBC that it was worth noting that the Department of Health’s response to criticism by family doctors was to say the bill was “going to get the market to work in favour of patients”. Thornberry noted: A third of the bill will create a new monster called Monitor … to “drive competition into the heart of the NHS’. Once you let that genie out of the bottle you can never put it back again. Meanwhile over at Channel 4, London GP Dr Jonathon Tomlinson argues that the NHS will be gobbled up by private companies. As Adrian Fawcett, CEO of the largest private hospital group in the UK – General Healthcare Group (GHG) – said: “We are entering a new, exciting era, driven by the forthcoming healthcare reform that will ultimately change, to our benefit, the landscape in which we operate.” I can imagine the future for my patients. Because of the cuts, several unprofitable departments in the local hospital will have closed. The services will hopefully be available elsewhere, but my patients will be forced to travel to unfamiliar and inconvenient places. They will be “allowed” to pay extra to jump queues for treatment, to have side-rooms in hospital or additional care. Those services that remain free will have long waiting lists and will be severely restricted, for example physiotherapy or psychotherapy will be limited to a handful of sessions with a junior practitioner. Simple procedures can be performed more efficiently and profitably than complex care, so that care for the elderly, home care, psychiatry, and treatment for addiction will be hit hardest because market incentives will divert resources towards the most profitable work. My job as coordinator of my patients’ care will be made impossible because of the huge array of different companies involved in looking after my patients. 12.05pm: The union of British doctors has just sent us their briefing paper for MPs ahead of today’s opposition debate. Essentially, the British Medical Association (BMA) seems to be saying that they’ll support Lansley’s bill, but only if all of its key demands are taken out. The letter reads: The bill brings into stark relief a number of grave concerns about the way the government wants to change the NHS, and the BMA believes that it requires significant amendment to prevent these concerns becoming reality. There remain considerable gaps, which must be addressed to ensure proper accountability, to prevent unacceptable variation and to ensure appropriate national oversight of key issues such as education, training and workforce. Here are a few of the BMA’s suggested changes: • Challenging the role of the health regulator: “Monitor’s primary role is not to promote competition but is to protect and promote high quality, comprehensive, integrated healthcare services.” • Maintaining the role of the secretary of state as having “ultimate overall responsibility” for the health service, with continued national oversight of medical education and training. • Challenging timetable to get rid of PCTs and make hospitals achieve foundation status. The BMA says that the timetable should remain flexible to prevent “artificially rigid” timetables undermining patient care. • The BMA also calls for “strong safeguards” to be put in place to ensure that patient confidentiality is not undermined by the Information Revolution. The head of the BMA, Hamish Meldrum, has already spoken out against the proposed reforms on this blog . 11.56am: Paul Corrigan, Tony Blair’s former health adviser, writes here about the planned health reforms. The killer paragraphs are here: On the ground there are already significant changes happening for patients. Last Thursday I received my first email advert from a private medical insurance company that was selling to me based clearly upon the impact of the Government NHS reforms. A firm providing users with an overall analysis of all private medical insurance, your health, your choice, beat that quote. Their offer recognised the return of waiting lists to the NHS, something that had become a thing of the past: “With this type of insurance you are able to avoid NHS waiting lists and secure treatment as quickly as possible.” Those selling private medical insurance recognise the anxiety that people on NHS waiting lists feel. They recognise that waiting lists have increased over the last year and that therefore they have an opportunity to sell to people on those lists. The government have withdrawn the necessity for the NHS to reduce waiting times and by doing so have renewed a market for private medical insurance that had been diminished by the success of the 18-week target. Up until this time last year I thought the NHS had won this issue. But in one short year the basket case that is NHS reform has increased waiting lists and reopened this market. 11.34am: Andrew George (left), the Lib Dem MP for St Ives, has sent a press release to the blog headlined: NHS reform: Better start afresh says Liberal Democrat rebel leader It’s true to say that George has been hostile to the coalition’s proposed reforms since they were first floated. But he is raising the stakes again today calling for a stop rather than a pause in the reforms. We have a chance to allow the coalition to mature now that it’s passed its first anniversary. We should work together where we agree; seek compromise where we don’t; and where comprise cannot be reached agree to take unresolved matters to parliament to decide. We should adopt “listening” as a theme for government, not as grudging concession when things start falling apart. The bill itself should be stopped rather than paused. Any policy which undermines the NHS ethos through marketisation, fragments services which need to be integrated and which hands executive power to a narrow group of clinicians who are reluctant to take on such responsibilities anyway is destined to fail. Any attempt to remove the duty on government to maintain a comprehensive NHS, as this bill does, should be vigorously opposed too. To use the language of the NHS chief exec – Sir David Nicholson – you should be able to see this government U-turn “from outer space”. If not then we should start again. I’m pleased that we’ve been able to turn the debate around since my lone voice protest 10 months ago. Saving the NHS is more important than saving a few egos in the coalition. Will anyone follow the rebel leader? 11.07am: With Labour and the Tories trading blows over health cuts, Randeep Ramesh has been digging around in some of the international data on health. A couple of things stand out: 1. According to the IMF: “The projections suggest that the outlook is grim in the United States, but also in Europe, where the fiscal challenge posed by health spending is sometimes underestimated.” IMF projected increase in public health spending in advanced economies, 2011-30, per cent of GDP: 2. Our GPs, according to the OECD, the rich world’s thinktank, are among the best paid in the world – see graph below. The truth is that about 40% of the government’s projected £20bn of savings comes from cutting staff costs – and that means taking on doctors over pay. While GPs are no doubt sincere in their attacks over the detrimental pro-competition aspects of the health bill, there is a question over whether doctors’ opposition is rooted in self-interest. 10.40am: How are health cuts affecting patients right now? In this audio interview , Rowenna Davis speaks to Linda Reason, the head of health and adult care at Barking and Dagenham council, and Anne Bristow, the director of adult and community services, to find out. In this interview, the council members explain how decisions are being taken “behind closed doors”. Senior cabinet members are only being told about spending cuts the night before they are due to be announced. Already they say that walk-in centres have been closed and access to GPs is being denied. A campaign to save services has also been launched, with almost 1,000 signatures collected so far. _ 10.12am: The Daily Telegraph’s political editor was briefed over the weekend that Downing Street has sent over his own health adviser to the Department of Health to “sell the reforms” . Sean Worth, who is currently David Cameron’s health adviser in Downing Street, will make the short journey across Whitehall and act as a close adviser to Mr Lansley. I am indebted to Andy Cowper , who points out that long ago health experts had singled out Worth as a safe pair of hands. Worth is a labour economist by training, and was behind the Tories’ voluntary insurance proposals to fund long-term care for the elderly. Henry Featherstone, formerly of Policy Exchange and now in PR, wrote this profile of Worth for the HSJ 100 . Featherstone presciently wrote that Worth is “politically astute and dedicated to market ideology”. Worth “will be relied on to push through reform if the DH stumbles”, she said. 10.00am: PoliticsHome (paywall) has been following former Liberal Democrat MP and practising doctor Evan Harris on Radio 5 Live. My colleague Andrew Sparrow over at the Politics blog emails with what Harris said: We have two conferences a year, in September and in March, and in March we identified democratically and clearly those bits of the bill that we didn’t like so yes you could say the Liberal Democrats formally didn’t reject until March a bill that wasn’t launched in January but there wasn’t any opportunity between January and March for us to identify what parts; we didn’t have the processes in place. 9.50am: Our health correspondent Denis Campbell just sent us his thoughts on the Royal College of GPs’ comments today. Here he questions the future of the health secretary at a time when many are describing the health bill as a “poll tax in an NHS uniform”: The Royal College of GPs’ submission to the government’s NHS “listening exercise” could not be more timely. Nick Clegg told Andrew Marr yesterday – bluntly, not in the usual political code – that the Liberal Democrats wouldn’t wear the health and social care bill unless it underwent major changes. Today GPs’ leaders are saying essentially the same thing. Significantly, the deputy prime minister yesterday said that “no bill is better than a bad one”. Given the chance the RGP would probably rather see the entire bill scrapped and the government start again from scratch in its approach to NHS reform. Interestingly, both the Lib Dems and the RCGPs – especially the latter – are pressing for changes to some of the bill’s real fundamentals, especially the planned ultra-intensification of competition in England’s NHS. That’s the element of health secretary Andrew Lansley’s plans that has caused the most trouble politically for the government; the fear, justified or not, that “any willing provider” and other elements of marketisation will see the NHS privatised. Every passing day makes Lansley’s hold on his job appear more and more tenuous. The fact that he remains convinced that his bill needs only minor changes shows how unsuited he is to playing a central role in the coalition’s post-”listening exercise” efforts to belatedly win hearts and minds in this most delicate of areas, the NHS. The bigger the Cameron/Clegg-agreed U-turn ultimately is, the worse his chances of survival. Increasingly he is in office but not in power. That is a real shame for a man who, whatever his failings, friends say is so genuinely, passionately committed to his vision of transforming the NHS for the best possible reasons. Can anyone think of such radical proposals from a cabinet minister in recent memory that have been so poorly explained, and so signally failed to gain consent and then had to undergo this actually extraordinary two-month “pause”? No wonder some critics see it as the poll tax in an NHS uniform. 9.43am: Here is today’s media round-up. The health reforms are dominating the news this morning, and we’ll be following up these stories throughout the day … • This morning a new report from the Royal College of GPs warned that the NHS could “unravel” if the health secretary’s reforms went ahead , as covered by the BBC . The college want the government to step back from introducing market forces into the NHS. Most important perhaps for patients is that family doctors won’t be able to charge the sick for coming into surgery. That commissioners or providers should not be able to charge patients for healthcare services that are currently provided free by the NHS or are recommended by Nice. • According to our colleagues over at the Politics blog , Conservatives aren’t happy about Nick Clegg’s comments over the weekend, when the deputy prime minister positioned himself against the reforms. • Last night the health secretary Andrew Lansley released a statement saying that new analysis of Labour’s spending plans shows that they would cut NHS budgets by £28bn over the next four years. The editor of the Spectator magazine, Fraser Nelson, sounds disappointed , saying he’s “singing someone else’s song”. • On the Today programme this morning, Norman Lamb, Nick Clegg’s point man in parliament, and John Redwood, the Tory right’s ideologue-in-chief, went head to head. Lamb, his party’s former spokesperson on health, said changes to the bill “shouldn’t be regarded as concessions to placate Lib Dems”. But Lamb did warn that US-style privatisation of healthcare would be a “disaster” and that there was a “concern” that the reform “elevates competition above other really important principles”. Redwood said he “loves the NHS” and accused the Lib Dem’s deputy leader Simon Hughes of “not understanding the NHS at all”. “These are coalition proposals that the Liberal Democrats contributed very strongly to.” Nick Robinson gave a great intro: describing the rise and fall of Andrew Lansley, Tory health secretary, in the eyes of the professionals and how an Orange Book Clegg advocated a European-style health system, where people paid insurance premiums rather than tax – and accurately described the NHS reforms as a contest between Lib Dems and Tories for “the credit” in changing the bill. 8.57am: The health secretary must be anxiously preparing for his appearance in the Commons this afternoon. This weekend Nick Clegg threatened to derail the minister’s plans to shake up the NHS unless they were significantly reformed. Today the Royal College of GPs has warned that the NHS could “unravel” if his health bill goes ahead. We’ll be live-blogging Andrew Lansley’s responses during health questions this afternoon, and a lot more besides. With a focus on cuts to health services, here is today’s star line up: Coming soon: Our health correspondent Denis Campbell gives us his thoughts on the report from the Royal College of GPs out today. 10:30am: Linda Reason, cabinet member for health and adult services in Barking and Dagenham, talks to us about what effects the cuts are having on patients right now. 1-2pm: Nick Seddon, deputy director of the liberal thinktank Reform, will be debating the case for cuts with Barbara McKenna, Unison’s head of health for the east Midlands, and Richard Grimes, who writes on health issues at Torylies . 3pm: We’ll be hearing from another senior Unison member about their meeting with the health secretary, straight after putting their concerns to him this afternoon. Also this afternoon – we’ll be live blogging the health questions as Lansley appears in parliament and covering the Labour opposition day debate. 4-5pm: Gary Walker, former chief executive at United Lincolnshire Hospitals Trust who presided over massive efficiency savings who now leads management consultant firm Modern Leader , comes on to tell us how it worked along with head of a health charity facing cuts (name tbc). NHS Health Health policy Randeep Ramesh Rowenna Davis guardian.co.uk