Nick Clegg: Health reform changes are the price of Lib Dem support

Nick Clegg has warned David Cameron he will not ask Liberal Democrat MPs and peers to support the Government's health reforms unless they are "substantially changed".

In a paper sent to the Prime Minister and seen by The Independent, Mr Clegg demanded four radical changes to the NHS and Social Care Bill during the "pause" the Government has called as it tries to allay fears about the reforms.

He warned that ministers must kill the impression that they have a "dogmatic obsession with competition" inside the NHS. And he said GPs should not be forced to commission services until they are ready – which would mean abandoning the Government's April 2013 deadline for this to happen.

Mr Clegg's strongly worded demands reflect his determination to claim credit for the changes expected to be announced next month as he seeks to convince his party and the public that the Liberal Democrats enjoy real influence on a key policy area.

But his campaign has irritated David Cameron, who also wants to claim ownership of the changes in an attempt to regain the public's trust on health, which has been eroded by fears that the reforms amount to of back-door privatisation. His advisers have told Mr Cameron that his mission to "decontaminate" the Conservative Party will not be completed if the Liberal Democrats are seen as "the Coalition's conscience".

Today Mr Cameron, Mr Clegg and the Health Secretary, Andrew Lansley, will meet the NHS Future Forum, composed of doctors and other health workers, voluntary sector and patients' representatives who are reviewing the Government's proposals, for a progress report on their work.

Mr Clegg's paper, headed "NHS reforms: changes required," says: "It is clear that the NHS does need to be updated if it is to meet patients' needs and provide world class health care in the future. But the reforms as originally set out would not achieve that goal, would not protect and sustain our NHS and have clearly very little support among NHS staff or the wider public. I will not ask my parliamentary colleagues to support legislation on the NHS until I am personally satisfied that the reforms have been substantially changed to ensure our NHS is secure for the future."

His campaign has angered Tory MPs. They have rallied behind Mr Lansley, who is under pressure to dilute his Bill from both Mr Cameron and Mr Clegg.

Although Mr Clegg insists he raised concerns about the package before Christmas, Tory MPs claim he supported the measures and backtracked much later.

Peter Bone, MP for Wellingborough, criticised Mr Clegg in the Commons yesterday, saying: "We have ministers who are seen to be opposing what they originally supported. Can we have a statement on collective responsibility and whether it only applies to Conservative ministers?"

Stephen Dorrell, Tory chairman of the Commons Health Select Committee which has proposed changes to the Bill, said competition already played a key role in the NHS. He said: "The idea there is no competition is just bonkers."

Changes demanded by Clegg

* "We must ensure that GPs only get involved in commissioning decisions once they are ready and willing"

* "The removal of any suggestion that we are pursuing a dogmatic obsession with competition [rather than] the best healthcare system in the world"

* "Preventing the cherry-picking of services by private providers to make sure NHS providers are not needlessly pushed into financial trouble and NHS research and training can thrive"

* "Enhancing governance and local accountability so decisions are transparent to all"