David Cameron today defended the radical shakeup of the NHS as he was accused of breaking promises and of being "arrogant" by pressing ahead with reforms despite warnings from unions and health experts over the plans.
The prime minister said the government was reforming the NHS "so that we have got the best in Europe" as he was challenged by both Labour and a member of the coalition benches over planned health service reforms at prime minister's questions today.
Ed Miliband, the Labour leader, said doctors and nurses had warned of "potentially disastrous" consequences for the NHS, while the Lib Dems' Andrew George, a member of the Commons health select committee, asked why the prime minister was taking a "gamble" over the shakeup.
Critics say the reforms are at odds with the Conservatives' election promise that there would be no top-down reorganisation of the NHS if the party was elected to power, with no trace of the plans visible in the Conservative manifesto or the coalition agreement.
With details for the radical plans, drawn up by the health secretary, Andrew Lansley, due to be revealed in the health and social care bill this afternoon Miliband described the proposals as the latest set of broken promises from the coalition government.
Amid concerns raised by professional health bodies over recent days, Miliband said Cameron appeared not to have noticed that people were not convinced by his reforms, "even the GPs sitting on his own benches", he said, in reference to Tory MP Sarah Wollaston who said it was like tossing a hand-grenade into the NHS.
"Why is he so arrogant to think he is right and all the people who say he is wrong, are wrong?" asked Miliband.
He also challenged Cameron to guarantee that waiting times would not rise under the government's plans.
Miliband said: "Patients want to know something quite simple: how long will they have to wait for treatment, because they all remember waiting for years under the last Conservative government."
Cameron said the waiting times were written into the NHS constitution and "would stay under this government" and said ministers wanted to see waiting times and lists come down.
Cameron said waiting times would rise if money was not put in to the NHS, telling MPs that shadow chancellor and former health secretary Alan Johnson had said there was "no logic or rationale" to the government's plan for above-inflation increases in health spending.
"The whole aim of these NHS reforms is to make sure we get the value for the money we put in," said Cameron.
The prime minister added: "We won't be able to get waiting times down, we won't be able to improve our public health in this country, unless we cut the bureaucracy in the NHS. That is what this is all about. We are spending £1.4bn – one off – to save £1.7bn every year that will save £5bn by the end of this parliament. If you oppose the reforms, where is that money going to come from?".
Andrew George asked Cameron whether he would reflect on the concerns aired by professional bodies about the reforms.
Cameron said ministers would listen "very carefully to professionals", before adding: "The reason we are making modernisation of the NHS a priority is simply this: we have now in this country, European levels of health spending, but we don't have European levels of success in our health service.
"Of course, what we want to see is a level playing field for other organisations to come into the NHS. What we won't have is what we had from Labour, which was a rigged market."
The Labour leader told Cameron the public could not trust the Tories on the NHS.
"He's breaking his promise on no top-down reorganisation of the NHS," said Miliband. "He's breaking his promise on a real-term rise in NHS funding, he's breaking his promise on a promise of 3,000 more midwives, and he's breaking his promise to put patients first. It's the same old story. You can't trust the Tories on the NHS."
Cameron said Miliband's stance appeared to be "no to the money, keep the bureaucracy, don't reform the NHS". He quipped: "I'd go back to the blank sheet of paper."
Whitehall sources say the radical, complex nature of the plans means the bill will be five times longer than any previous health legislation, including the 1946 act that established the NHS, the Guardian reported today.
A study by the Nuffield trust, also published today, could turn patients against GPs because doctors are likely to start receiving "unpalatable" cash bonuses.
Cameron was also challenged on latest unemployment figures, published today, which showed unemployment has soared by 49,000 to 2.5 million, with youth unemployment moving closer to the 1 million mark.
The total number of adults under 25 who are out of work hit 951,000 in the three months to November, just 1,000 short of its record high. There was a particularly sharp rise in the number of 16- and 17-year-olds classed as unemployed, rather than in employment or education, up to 204,000 from 177,000 in the previous quarter.
The statistics will fuel fears that Britain's young people could become a "lost generation" who cannot find work despite the recession ending a year ago.
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