The Government's flagship health reforms face their final crucial hurdle this week as Labour urges the House of Lords to "kill the Bill" in order to save 6,000 nursing jobs. An alliance of Labour, Liberal Democrat and independent crossbench peers will back a series of amendments to the troubled Health and Social Care Bill, which returns to the second chamber on Wednesday. Although ministers have already made concessions, Liberal Democrat peers are demanding more changes to dilute the role of market forces and a declaration that the NHS will be based on "quality, not price".
Some senior Tories are worried that the heated debate on health will damage David Cameron after his assurances that the NHS is safe in his hands, and that cuts due to a cash squeeze will be blamed on the shake-up. Some Tories privately want to scrap the Bill at this late stage, which would be a humiliation for Andrew Lansley, the Health Secretary, who has already been forced to water down his original plans. But ministers insist it is too late to scrap the measure now because changes to put GPs in the driving seat on commissioning care are already being implemented.
While Nick Clegg is urging Liberal Democrat peers to fine-tune rather than emasculate the Bill, they were given a green light to seek major changes yesterday by Tim Farron, the party's president. He said a "pretty appalling" Bill the Liberal Democrats would never have introduced had been changed for the better but was not perfect and Liberal Democrat peers would seek "further concessions". He told Sky News: "I want to make sure if there is any competition at all, it has got to be competition on quality and not on price."
Today, Labour will go for broke, telling peers they can kill off the measure entirely if they work together. Ed Miliband will claim that 3,500 nursing jobs have already been cut since the Coalition took power and another 2,500 are threatened. He will argue that all 6,000 could be saved at a cost of £748m if the £1.7bn NHS shake-up is halted.
Mr Miliband will say: "Labour's priority is protecting the front line, not a pointless and damaging reorganisation of the NHS. So we are calling for the Bill to be scrapped, and for some of the money set aside to fund this reorganisation to instead be made available to the NHS to protect the thousands of nursing posts either already cut or set to be cut in the coming years. It is a clear and simple choice for the Government: by stopping this damaging reorganisation we can fund 6,000 nurses."
Mr Miliband will argue that it is not too late to stop the reforms and offer talks with the Government on salvaging some of its proposals on GP-led commissioning if it withdraws the Bill. Labour claims such commissioning could be done more cheaply through the existing NHS structure. Andy Burnham, the Shadow Health Secretary, said yesterday: "If this Bill goes through, it's the end of the NHS as we know it. It's a genie-out-of-the-bottle moment. Once they pit one hospital against another, in a competitive market, that is a break with 63 years of NHS history." After a series of professional groups representing NHS staff came out against the changes, Labour hopes an alliance of "patients, professionals and now Parliament" will now bury them. Mr Miliband has already used the threat of a key vote in Parliament to force Rupert Murdoch to withdraw News Corporation's bid for full control of BSkyB and to persuade Stephen Hester, the Royal Bank of Scotland chief executive, not to take his bonus of almost £1m.
Simon Burns, the Health minister, insisted the reforms would save £4.5bn by the next election, every penny of which would be reinvested in health care. He dismissed the professional groups against the changes as "basically trade unions and organisations that are out of touch with many of their members".
Labour will use a Commons debate tomorrow to claim that the Government could veto big bonuses proposed for six Network Rail bosses. Justine Greening, the Transport Secretary, said yesterday that she would use the Government's "special member" status at the company to vote against the payments but that she could not halt them. But last night Labour published documents which, it said, showed that bonuses need "prior written consent" from the Department for Transport.