David Cameron issued a robust defence of his decision to introduce "substantive" changes to the government's NHS reforms, hailing the move as a "sign of strength".
As Ed Miliband accused the prime minister of planning to waste billions of pounds in a "bureaucratic reorganisation", the prime minister said the revisions would allow the NHS to thrive as a service free at the point of delivery.
The government has been under in recent weeks fire for embarking on a series of policy U-turns, most notably its plans to water down health secretary Andrew Lansley's proposals for greater competition to the NHS and to hand 65% of the NHS budget to new GP-led consortiums.
The prime minister, who outlined significant alterations to Lansley's blueprint at Guy's hospital in London, tried to make a virtue of his change of heart.
Standing alongside Nick Clegg and Lansley, he said: "Politicians aren't very good at saying, we didn't get it right first time. Politicians hate it if they ever get anything wrong.
"But actually I think people respect a government that feels it is strong enough to say, hold on, we haven't got every element right, we're not taking enough people with us, let's stop, let's get this right. That is what you do in any other walk of life, so it seems perfectly good common sense to do it in government. I think people respect that.
"I think it is a sign of strength to pause, to change, to improve and to recognise you'll have a pretty uncomfortable couple of months and people will throw a few bricks at you. But so what?
"The NHS is too precious, this is too important not to get it right. I absolutely think we have done the right thing. I think it has been a good process. I really paid tribute to the Future Forum and the way they have run it. We have had a massive engagement and as a result we have [emerged] much stronger and can now go ahead." The prime minister defended his performance after the government accepted the bulk of a report on the health and social care bill by an independent panel of experts.
Cameron appointed the Future Forum in April amid Liberal Democrat concerns about creeping privatisation and Tory fears that it was jeopardising his work in neutralising the NHS as an issue on which voters used to distrust the Conservatives. He announced that the bill will be amended to make clear that the primary duty of Monitor, the health service regulator, is not to promote competition. It will only do that if it helps patients. Cameron said: "You wanted us to make clear that competition isn't there for its own sake, but to make life better for patients – done." The membership of the new GP-led consortiums will be opened up. "You wanted us to get specialists, not just GPs, on commissioning groups – done," Cameron said. "You wanted us to join up the different parts of the NHS, to put integration right at the heart of our reforms – done. We have listened, we have learned, and we are improving our plans for the NHS. We come here today with a substantive package of changes."
Among other changes to the plans:
• Clegg announced that the proposal to allow "any qualified provider" to deliver NHS services will be introduced at a slower pace.
• Lansley confirmed that his original 2013 deadline should be relaxed. The department also confirmed that the "relevant parts" of the health and social care bill will be sent back for consideration at the Commons committee stage.
Sir Stephen Bubb, who runs the Association of Chief Executives of Voluntary Organisations and who wrote the competition chapter in the Future Forum report, indicated that the changes would make little difference to the level of competition in the NHS.
Asked on Channel 4 News whether there would be more or less competition or whether it would remain the same, Bubb said: "I suspect it will."
Miliband said: "The best thing the government could do is go back to the drawing board because they are still going ahead with a bureaucratic reorganisation."
Cameron and Clegg had an awkward moment when they were interrupted as they chatted to a patient in a ward at Guy's for the benefit of the cameras.
"Excuse me, I'm the senior orthopaedic surgeon in this department," a man said, as he took exception to a camera crew and Downing Street aides on the grounds that they had not taken the correct measures to comply with hospital hygiene rules.
"Why is it that we're all told to walk around like this and these people ... " he added as he stormed out. Cameron told his staff to leave the ward.
