Clegg breaks ranks to demand more amendments to NHS Bill

Attempt to appease party faithful comes on day PM asserts: 'there will be no more big changes'

Nick Clegg yesterday called for a further watering down of competition rules in the Government's controversial health Bill to head off a rebellion from his party's members at the Liberal Democrats' Spring conference next week.

Only hours after David Cameron's official spokesman said there would be no more "significant changes" to the Health and Social Care Bill, Mr Clegg released a letter sent to Liberal Democrat MPs and peers calling for further moves to restrict private competition in the NHS.

It came as hospital doctors voted to survey their 26,000 members on whether to call for the Bill to be scrapped.

Publicly, senior Conservatives said they were relaxed about the letter, which they said had been cleared with David Cameron, but privately some accused the Deputy Prime Minister of playing "dirty politics". They suggested the changes to the Bill demanded by Mr Clegg had already been broadly agreed by the Coalition. They added that the Liberal Democrats were attempting to claim political credit for forcing further concessions from the Tories despite having previously backed the Bill after last year's "listening exercise". "This was something Clegg told Cameron he had to do to keep his party on side," said one. "Are we happy about it – not particularly. But that's Coalition politics."

However, sources close to Mr Clegg denied this. They said the changes demanded by the Liberal Democrats were significant and were about reassuring people who had "legitimate concerns" about the legislation as currently drafted.

In the letter, which was also signed by the Liberal Democrat peer, Baroness Williams, Mr Clegg said he wanted to see changes to the Bill "to make sure that the NHS can never be treated like the gas, electricity, or water industry".

He cited three areas where he believed further changes were necessary: Preventing the NHS from being subject to European competition laws, increasing safeguards to ensure that hospitals could not put the interests of private patients above the NHS and removing the role of the Competition Commission from the Bill. Asked later whether Mr Clegg's demands amounted to "significant changes" Mr Cameron's spokesman said: "We accept that some people require further reassurance on issues relating to competition. We are happy to provide that."

But privately some of those close to Mr Cameron were less sanguine. One said the Prime Minister was "irritated" by the behaviour of Mr Clegg. Shortly before the letter was issued, Tory health minister Simon Burns had insisted the whole Government backed the Bill.

Labour described the letter as "stage-managed" and said it was part of a "face saving exercise for Nick Clegg". "He must accept his share of the blame for the mess which has been created," Shadow Health Secretary Andy Burnham said.

In a further embarrassment to the Government, the Royal College of Physicians (RCP), representing hospital doctors, formally agreed yesterday to survey its members for their views on the Government's health reforms.

Protesters calling for the Bill to be withdrawn also chained themselves together to block the street leading to the entrance to the House of Lords.

Campaigner Shirley Murgraff, 81, from Hackney, east London was carried off by police officers after refusing to move from the middle of the road.