Upheaval in Coalition over NHS plans in England

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The longest National Health Service bill in history returns to the Commons tomorrow amid rising anger over its provisions to increase competition and the role of the private sector.

More than 1000 amendments have been made by the Government since a summer "listening exercise", but it still faces the prospect of a Liberal Democrat revolt.

Opposition to the Health and Social Care Bill in the Lords will be championed by Baroness Shirley Williams, who warned yesterday that LibDems still had huge concerns over the planned reforms.

She said there was legal doubt over whether it would require the Health Secretary to deliver a "comprehensive health service for the people of England, free at the point of need".

She questioned why ministers had become bewitched by the market system run in the United States, when the NHS was among the most efficient, least expensive and fairest anywhere in the world.

It has emerged that the Department of Health had discussed handing management of up to 20 failing hospitals to private companies overseas.

Emails released in response to a Freedom of Information request revealed management consultants McKinsey had acted as broker between the department and foreign firms for contracts worth millions of pounds.

The department said that NHS staff and assets would always remain wholly owned by the NHS.

The disclosure fuelled protests from unions campaigning against the reforms. Christina McAnea, Unison's head of health, accused the LibDems of colluding with the Tories to "break up and privatise the NHS".

Health Secretary Andrew Lansley said: "Claims that we aim to privatise the NHS amount to nothing more than ludicrous scaremongering.

"The reality is that we're giving more power and choice to patients."

The management expert Sir Geoffrey Robinson will warn on BBC1's Panorama today that the reforms could spell the end of the NHS unless they created a management structure able to take difficult decisions on hospital closures.

"The stakes here are huge," he said. "The very existence of the NHS could depend on getting this right."

Imminent closures

* Accident and emergency, children's and maternity services at Chase Farm Hospital, Enfield, are due to move to Barnet and North Middlesex Hospitals. Approved by the Independent Reconfiguration Panel - awaiting decision by the Secretary for Health, Andrew Lansley.

* Accident and emergency and maternity services at King George Hospital, Ilford, are to move to Queen's Hospital Romford. Referred to Independent Reconfiguration Panel which submitted its recommendation to the Health Secretary in July - decision awaited. Barking, Havering, and Redbridge University Hospitals NHS Trust were 34 million in debt at the end of 2010-2011.

* Accident and emergency at Queen Mary's Hospital, Sidcup, was closed last December. However, South London Healthcare NHS Trust ended 2010-2011 with a 45 million deficit. Further closures are expected as the trust struggles to meet PFI (private finance initiative) payments that are already more than 15 per cent of its income.

- Independent