Critics warn that parts of the Government’s plan to share patient records with private companies give real concern over personal data privacy issues.Mr Burnham said it is “absolutely essential” that patient data is safeguarded, after The Sunday Telegraph revealed David Cameron will use a keynote speech to outline far closer “collaboration” between the health service and life science companies.

The Prime Minister will say that the controversial industry has the potential to be a powerhouse of Britain’s 21st century economy, but that it is stifled by excessive regulation at present.

Speaking to Sky News, Mr Burnham said that while he did not object in principle to close ties between the NHS and private sector life science companies, he was concerned that “one of the patients’ groups that was on the working group looking at this issue has walked away”.

“That gives real cause for concern and rings alarm bells” he said. “The Government simply can’t say: ‘This is all red tape and it all must be brushed away’”.

“Proper regulation, essential safeguards need to be in place when it comes to the use of patient data.”

The move, which will give life science companies more freedom to run clinical trials inside hospitals, is likely to face a backlash from privacy campaigners who have consistently opposed private companies being given access to medical records.

There will be particular opposition from animal rights activists who object vehemently, and sometimes violently, to vivisection, while religious groups, particularly the Roman Catholic Church, could object to firms that use stem cells harvested from embryos being allowed access to NHS data.

One senior executive at a leading drugs company well-known for using animal testing said: “You can look at the NHS as one massive database with 60 million people in it.”

The Prime Minister will stress that greater integration between private companies and the NHS could advance medical science, give patients greater access to cutting-edge treatments and save money, while boosting economic growth.

With Britain teetering on the brink of a double-dip recession, ministers are keen to show that they have a positive vision of the future.

“Britain has the potential to become a powerhouse in the world’s life sciences industry,” said a Downing Street source this weekend.

“We want to see much closer collaboration between the NHS and life science companies — not just greater data-sharing, but more clinical trials in hospitals.

“These changes will not only boost the industry, but also potentially give the NHS early access to new, innovative drugs treatments.”

Welcoming the move, Andrew Witty, the chief executive of GlaxoSmithKline, one of the world’s largest pharmaceutical companies, said: “Any action the Government takes to improve the environment in this country for life science across these activities is welcome.”

Britain is considered uniquely placed to become a world leader in life sciences because of the strength of scientific research at its top universities and the amount of data and expertise amassed by the NHS since its creation in 1948.

The industry already employs about 160,000 people in 4,500 companies, ranging from large multinationals to small businesses.

These firms employ highly skilled researchers with PhDs down to lower-skilled workers in drugs manufacturing plants.

Whether such companies would be charged for access to NHS records was not clear.

Although personal information should be anonymised, the public sector has an appauling history of handling the personal details of citizens.

Numerous health trusts have been criticised for losing patient records in recent years and HM Revenue & Customs has previously lost the financial records of millions of taxpayers.

Privacy campaigners led a vigorous campaign against the previous Labour government’s plans to place every medical record on a central electronic database.

It is understood that the Medicines and Healthcare Products Regulatory Agency would oversee the sharing of NHS data with businesses.

Joyce Robins, from Patient Concern, said many people would be “deeply disturbed” by the notion that their private medical records could be handed to firms seeking new markets.

“Even when they say records will be anonymised, the amount of detail contained in medical records means that companies may be able to find ways to target people with particular conditions,” she said.

“This data is absolutely private; it is not the Government’s to give.”

Health Direct has long warned that patients’ personal data security.

If the Government is genuine in their desire to speed up drug development- they ought to cut red tape.

10 years ago 10% of all new drugs developed in the world were tested in the UK. Since labour created the killer quango National Institute for Curbing Expenditure (NICE) this figure that fallen to only 3%.

Controversial reforms to the NHS have avoided a potentially “fatal” delay in the House of Lords, to the relief of ministers.Amid deep concern in the medical profession and among many members of the public, some peers had tried to have the Health and Social Care Bill thrown out or subjected to detailed scrutiny that would have ruined the Government’s timetable.

It is feared by opponents that the wording of the legislation will remove the Secretary of State’s duty to provide healthcare for all, while plans to widen competition will see the back-door privatisation of the NHS.

But following two days of debate by 100 members of the upper house, and pressure applied by ministers and whips to Tories and Lib Dems, attempts to delay or thrown out the Bill were defeated comfortably in the biggest turnouts seen in the Lords for more than a decade.

A motion by Lord Owen, a former health minister and SDP leader, to let a special committee spend until Christmas studying the constitutional impact of the reforms was rejected by a margin of 330 to 262.

Labour’s Lord Rea had wanted the second reading to be refused altogether but this proposal was lost by 354 votes to 220.

Baroness Williams of Crosby, the Lib Dem grandee who had been among the first to raise fears over the Bill, abstained on the critical Lord Owen vote and went with the Government on the Lord Rea motion.

The results means the Bill, which seeks to remove two tiers of NHS management and give more power to GPs and patients, will now be considered line-by-line in committee stage in the Lords and remains on track to receive Royal Assent by next summer.

It has already survived a rebellion by Lib Dem activists in the spring and an unprecedented “pause” in the parliamentary proceedings for doctors’ concerns to be heard, which led to competition plans being watered down.

But even the Government accepts that more changes will be made to contentious areas.

A Department of Health spokesman said: “The vote today moves us one step closer to delivering a world-class health service that puts patients at its heart and hands more power to health professionals. We now look forward to working with the Lords to scrutinise the Bill during Committee Stage to improve our plans further.”

Labour said it would continue to call for “drastic changes”.

The plans had been criticised in the debate by well-known figures including Lord Winston, the fertility pioneer, who described the Bill as “unnecessary and, I’m afraid to say, irresponsible”.

After the vote Dr Hamish Meldrum, Chairman of BMA Council, said: “It remains the BMA position that the Health and Social Care Bill should be withdrawn, or if not that it should be substantially amended, and we will continue to raise our concerns at every available opportunity as the Bill progresses through the House of Lords.

“The BMA continues to have many areas of concern, including the need for assurance that increasing patients’ choice of provider for specific elements of their care won’t be given priority over the development of integrated services and fair access.

“We also need to see an explicit provision that the Secretary of State will retain ultimate responsibility for the provision of comprehensive health services.”

From: http://www.telegraph.co.uk/NHS-reform-Bill-survives-fatal-Lords-vote

David Cameron has agreed to make changes to the plans for the NHS in England and insisted the government had not made “a humiliating U-turn”.
Ministers have accepted all the recommendations suggested by a panel of experts, including more controls on competition and a slower pace of change.

Doctors’ groups have broadly welcomed the revisions.

The NHS bill will now go back to the committee stage in the House of Commons to be scrutinised again by MPs before going through its House of Lords stages.

The prime minister’s official spokesman said he expected that to happen before the summer recess begins in July, and the bill to be on the statute book by the end of the current Parliamentary session.

That gives ministers until May 2012 to make it law.

On Monday – following a 10-week “listening exercise” – a panel of experts called the NHS Future Forum gave its recommendations on the changes needed to the bill.

They include:

• Reinstating the legal responsibility of the health secretary for the overall performance of the NHS
• Scrapping the primary role of the regulator, Monitor, to promote competition – and focusing on improving patient choice instead
• Relaxing the 2013 deadline for new GP commissioning arrangements to be introduced – a National Commissioning Board, based in Leeds, will control budgets until GP groups are “able and willing” to take over
• Strengthening the power of health and well-being boards, which are being set up by councils, to oversee commissioning and giving patients a greater role on them
• Retaining a lead role for GPs in decision-making, but boosting the role of other professionals such as hospital doctors and nurses alongside them

After criticism from medics and complaints from rebellious MPs, the Coalition will be hoping the dust will now settle over its NHS reforms.

If politics is the art of persuasion, then the test for Messrs Cameron, Clegg and Lansley is whether or not they have convinced people that the listening process has been, as the prime minister claimed, a sign of strength.

The government and many health professionals believe changes to the NHS are necessary to deal with the demands of the ageing population, cost of new drugs and lifestyle changes such as obesity.

Mr Cameron said those who described the reworking of the plans as “a humiliating U-turn”, or the listening exercise as “a big PR stunt”, were both wrong.

“The fundamentals of our plans – more control to patients, more power to doctors and nurses, less bureaucracy in the NHS – they are as strong today as they’ve ever been,” the PM said.

The health secretary has faced personal criticism for his inability to garner widespread support for the original bill, but the prime minister said he accepted full responsibility for what had happened.

“I am every bit as responsible as Andrew Lansley for the fact that we actually decided we could improve on what we already put forward,” Mr Cameron said.

The British Medical Association said it was pleased the government had accepted the Future Forum’s recommendations and addressed many of doctors’ concerns.

But it said more detail was needed on how commissioning of care would work in future and there must be “robust safeguards” to prevent competition of any kind destabilising the health service.

From: http://www.bbc.co.uk/news/uk-politics-13757380

David Cameron will commit to “five guarantees” on the future of the National Health Service in a speech designed to reassure critics of his controversial health reforms.The Prime Minister will promise to keep waiting lists low, maintain spending, not to privatise the NHS, to keep care integrated and to remain committed to the “national” part of the health service.

Such is the concern in Downing Street at the damage the issue of NHS reform is causing the Government, that Mr Cameron will put his reputation on the line with a personal pledge to protect its core values. It represents his boldest attempt yet to assuage criticism from his Liberal Democrat Coalition partners and from many health professionals over the impact of the reforms.

In his speech, the Prime Minister will admit that he is willing to act on their concerns after listening to the “profession and patients” during a two-month exercise which was held after Mr Cameron called for a “pause” in the Health Bill’s passage.

His “five guarantees” are designed to show the Prime Minister is committed to the NHS, and “he is hearing what is being said”, according to one source. Mr Cameron’s promise on integrated care is designed to ensure patients receive continuity of treatment, without having to explain their condition from scratch each time to different doctors.

It also means that nurses and hospital professionals will retain a role in commissioning services, and that not everything is transferred to GPs.

His commitment to the “national” part of the NHS represents a pledge to keep it as a universal service, free at the point of use. But Mr Cameron will also say that “no change” is not an option.

He will echo the words of Andrew Lansley, the Health Secretary, who wrote in last week’s Daily Telegraph about the threat to the NHS if it does not reform. He warned of a £20 billion a year funding black hole without reform.

Despite ring fencing health spending, Mr Cameron is expected to make clear that NHS services will be threatened unless there is reform because of the rising costs of drugs and an increasing elderly population.

Mr Cameron is likely to say that the Coalition’s reforms will see the NHS working better. He will point out that in Europe there are health systems which work more effectively.

The speech comes as ministers prepare to rewrite much of the Health Bill. At present the plans involve abolishing two tiers of NHS management and handing control of a £60 billion-a-year budget to groups led by GPs, who can choose to buy treatment for patients from local state-run hospitals or private providers.

This week, the Royal College of Nursing is expected to renew its call for nurses to have a key role on the GP commissioning boards. Mr Lansley will not commit to such a plan until he has heard from the Future Forum, which is reporting back on possible changes to the Bill.

Tomorrow, Mr Lansley, who has been subject to rumours that he is about to resign or be sacked over the issue, faces MPs in the Commons. He will defend the reforms, although he is prepared to see them substantially watered down. However, Labour will seize on stories circulating that Cabinet colleagues had suggested he would not last the year in his post.

Downing Street polling has painted a stark picture of the problems Mr Cameron faces over the NHS and Mr Lansley’s presentation of the plans over the past 12 months is being blamed.

Last week Stephen Dorrell, who was health secretary in John Major’s government, added to speculation that he will replace Mr Lansley. Asked on BBC’s Question Time about whether he would do a better job, he said: “I am going to plead the Fifth Amendment.”

From:
http://www.telegraph.co.uk/David-Cameron-puts-reputation-on-the-line-with-five-pledges-on-the-future-of-the-NHS

David Cameron has been urged to step in with a “rescue plan” for more than 30,000 elderly care home residents as Britain’s biggest private care provider faces financial ruin.
Elderly campaigners, charities and union leaders warned that the threat of collapse at Southern Cross Healthcare Group would be a “catastrophe” that could threaten the lives of residents at its 750 homes.

In response, Downing Street offered a “guarantee” that elderly and disabled people in Southern Cross homes would not lose out, but declined to say whether any emergency funding would be available.

The crisis comes as the public spending watchdog, the Audit Commission warns that the quality of services for elderly people will be under further threat as councils are forced to negotiate lower fees for private care places.

Southern Cross, which made a £311 million loss in the six months to the end of March, has blamed its problems on reduced council spending on long-term care. The group announced this week that it will be forced to cut the rent it pays to the landlords of the homes it runs by 30% for four months.

Saga, the over-50s group, called on ministers to draw up an urgent “rescue plan” for care homes in trouble. Ros Altmann, Saga’s director general, said: “The government and local authorities may have to step in and take control of the situation.

“There must be a plan for rescuing failed care homes, to protect their elderly residents properly. Of course some homes do fail, but not on a massive scale like this.

“Lives could be at risk as a result of Southern Cross collapsing.”

The GMB union, which has around 12,000 members working in the care homes, urged politicians across the UK to take action to help secure the future for the staff and the residents.

General secretary Paul Kenny said politicians must “sort out the uncertainty” the residents face. “These are not factories facing closure, they are a vital part of the social fabric of every community,” he said.

The Prime Minister’s official spokesman gave a guarantee that affected residents would not “lose out”.

“We are clear that we are putting the interests of residents at the top of the list,” he said. “It may well be in their interests to keep them in the same place. But I think we have to look at that very carefully and we have got to let this process continue with the company and the various other interested parties.”

However, he declined to discuss whether there was any contingency in care budgets to cover extra costs. Southern Cross is in talks with its landlords, who could force the group into deeper trouble if they refuse to agree to the rent cut.

Jamie Buchan, chief executive of Southern Cross, said he believed the company would survive, with fewer homes, but there would be no “need” for a government bail out. He told The Daily Telegraph: “I don’t think the Government would or would need to provide financial support.”

From: http://www.telegraph.co.uk/Southern-Cross-residents-need-government-rescue-plan

The NHS and social care services will “collapse” unless the Coalition’s health reforms are enacted because of growing demand from elderly people, Saga and Age UK have warned.
Ros Altmann, director-general of Saga, said stalling reform was “not an option” due to growing numbers of the very old and frail. Michelle Mitchell, charity director of Age UK, added that reform was essential because there was “little or no joint planning” on how to care for the elderly.

Their calls come a day after a group of 42 senior GPs wrote in the Telegraph that the Health and Social Care Bill would lead to “enormous benefits” for “the most elderly, infirm and vulnerable in society”.

This was because the formation of Health and Wellbeing Boards on local councils would “coordinate all aspects of care … into a coherent and seamless whole”.

For decades elderly people had been shunted into hospital when they did not really need to be there because growing demand for social care, such as home care assistants, had been neglected.

She thought the Bill offered a vital opportunity to change the situation.

“We will have to address this and integrate, so let’s get on with it,” she said. “None of this is going to be easy, but so far we have not had any serious attempts to solve it. After pensions, it’s the next crisis coming down the tracks.”

“I’m hoping that this Government is really serious about getting it right, rather than doing the spin. I’m reasonably optimistic.”

She hoped reforms would lead to GPs being able to prescribe “domiciliary care” for elderly people while they could not cope at home, for example after a minor fall, “just as they prescribe drugs now”.

Such a move would stop large numbers being admitted to hospital and becoming “bed blockers”.

Ms Mitchell said: “At the moment, silo thinking means that health and social needs are not considered as a whole and there is little or no joint planning between the respective services.

“If the Government is concerned about how best to meet the needs of older people with complex needs, joining up services is a must.”

Ruth Isden, the charity’s public services programmes manager, said improving “poor coordination” could deliver “huge benefits” for patients and large efficiency savings.

But she warned that the Health and Wellbeing Boards, as currently envisaged, “do not have a strong enough role”.

Local public health and social care directors will sit on them with GPs to formulate strategy. She said the boards needed to be given “teeth” to ensure the GP consortia followed through.

Meanwhile, Ed Miliband, the Labour leader, admitted that sticking with the status quo on the NHS was not an option.

From: http://www.telegraph.co.uk/NHS-will-collapse-without-reform-warns-Saga

Hospital casualty departments are struggling to cope with growing demand for emergency care because they have too few staff and not enough beds, Britain’s top accident and emergency doctor has warned.
As new figures pointed to a steep rise in A&E waiting times and 890 ambulance jobs were lost, John Heyworth, president of the College of Emergency Medicine, joined a growing chorus of doctors warning that the NHS funding pressures are already hitting frontline services.

“The emergency care system is struggling to cope at the moment,” he said. “Many departments spend their time firefighting because of the number of patients coming in, the limited number of emergency department staff and limited availability of beds.”

David Cameron and the health secretary, Andrew Lansley, have insisted that the NHS will not be affected by the deep cuts to public spending elsewhere and that frontline services will be protected during their shakeup of the health service.

But medical organisations, health charities and patients’ groups are increasingly sceptical that the pledge can be kept as health spending fails to keep pace with the rising cost of treating Britain’s ageing population.

“The line that the NHS is being protected from cuts – even to frontline services – is looking increasingly absurd”, Dr Hamish Meldrum, chairman of the British Medical Association’s ruling council, told the Guardian on Tuesday. “The financial pressures are really starting to bite and these are yet more examples of vital services that are showing signs of the strain and that will be stretched to the limit.”

Heyworth pointed to NHS figures showing a steep rise in patients waiting more than four hours for A&E treatment, saying they showed “an increasing mismatch between ever rising demand, ever limited emergency medicine consultant numbers, which are woefully inadequate, and limited hospital bed capacity for emergency patients.”

The hospital statistics reveal that 292,052 people in England were not treated within the four-hour target between July and December last year, soon after Lansley announced in June that he intended to scrap the rule. That was up from 176,522 patients in the same period in 2009 – a 65% leap inside one year.

The A&E statistics coincided with the axing of 890 jobs by the London Ambulance Service (LAS) and the disclosure that services in which specialist nurses help people with diseases such as cancer and diabetes are also facing cuts.

The ambulance service cuts in London will see 560 frontline posts disappear, including paramedics. The capital may also see some of its ambulance stations close, while, according to LAS chief executive Peter Bradley, solo paramedics rather than two-person crews will start responding to more callouts from September as part of a drive to save £53m over the next five years.

“Unfortunately we are not immune to the financial pressures facing the NHS,” he said. “With nearly 80% of our budget spent on staff costs it would be impossible to make the savings required without removing posts.” The health union Unison’s regional organiser, Phil Thompson, warned the cuts could endanger patient safety. “These cuts are so deep they may not heal. With demand escalating and nearly 1,000 fewer staff no one can now be sure of a safe service.”

The ambulance cuts prompted the NHS chief executive, Sir David Nicholson, to issue his second reminder in 72 hours to health service managers that there should be no cuts to patient services as part of the drive to make £15bn to £25bn in “efficiency savings” by 2015.

From:  http://www.guardian.co.uk/nhs-funding-pressures-hitting-frontline

David Cameron will this week take personal charge of the Government’s health reforms, amid fierce criticism of the plans.
The Prime Minister will unveil a “listening exercise” to reassure the public, doctors and Coalition MPs that the NHS is not being privatised by the back door.

There will be a three month pause in the legislative process which allows Liberal Democrat opponents of the plans time to weaken them. The proposals will pass to the Lords in June, giving the Coalition time for further changes.

Mr Cameron, Nick Clegg, his Lib Dem deputy, and Andrew Lansley, the Health Secretary, will explain the plans to give power to GP–led bodies and let private companies treat more NHS patients at a series of meetings.

They have been forced into the move after criticism from health experts and politicians.

Stephen Dorrell, the former Tory health minister, said that the Government had lost control of the changes. The electorate had the impression the reforms were an abrupt departure from those followed by health secretaries over the past two decades, he said.

“There’s a danger that the politics is seriously getting in the way of the policy,” he said. “The Government needs to rebuild political support.”

Officials have signalled that the Government is prepared to make some changes to the legislation to appease the Liberal Democrats.

These include the dropping of a requirement to force GPs to take control of health budgets even if they do not want to. There will also be new protections so that private firms cannot “cherry pick” the most lucrative work. Any changes are expected to be made during the Bill’s passage through the Lords in June.

Lib Dem backbenchers will meet on Monday evening to discuss what Mr Clegg should ask for in his negotiations.

Today MPs on the Health Select Committee will issue a report likely to be critical of the contentious issue of GPs commissioning care.

From: http://www.telegraph.co.uk/David-Cameron-to-take-charge-of-under-fire-NHS-reforms

David Cameron has defended the coalition’s plans for an overhaul of the NHS in England, as MPs hold their first debate on the bill.
The prime minister said the “biggest risk” to patients was failing to modernise in the face of challenges such as the ageing of the population.

Under the plans, GPs will get control of £80bn of the NHS budget from 2013.

Health unions have denounced the changes and Labour say the Lib Dems may be blamed for any consequences.

NHS workers from around England are expected to protest against the government’s bill in London on Monday.

Under the plans, all 151 primary care trusts and strategic health authorities will be disbanded.

So far, 141 GP consortiums, serving more than half of the population of England, have signed up as “pathfinders” to pilot the new arrangements.

Mr Cameron said “If you look at the growth of the elderly population, look at the new drugs that are coming on stream, the new treatments, if we keep the system we have now and don’t make changes to cut bureaucracy and waste, I think it will become increasingly unaffordable. The risk is doing nothing.”

He added: “Of course, some of the trade unions are nervous about this because it will mean greater choices for GPs and patients. It will mean that, for instance, they will be able to choose between hospitals and between services and sometimes trade unions don’t like that sort of choice.”

The prime minister moved to reassure voters, saying: “There is no privatisation taking place. The NHS will be just like you experience it now – it is free at the point of use, you don’t pay anything, and it is according to your need.

“But I think it is a good thing if patients and their GPs are able to choose between different providers.”

BBC political correspondent Carole Walker said that, despite all the controversy, the government was not anticipating a significant rebellion when MPs vote later on the government’s Health Bill.

The NHS Confederation has warned that hospitals could go bust by opening up the NHS to “any willing provider”.

Critics have also questioned whether GPs have the experience and skills to handle such huge budgets – they will have control of about 80% of the NHS budget.

From: http://www.bbc.co.uk/news/uk-12321166

The Government cannot afford to delay essential reform of Britain’s public services, David Cameron warned yesterday.
As ministers prepared to publish legislation to radically overhaul the NHS, the Prime Minister said that failure to modernise was draining resources away from the public sector.

The Government’s plans for the NHS were denounced by six health service unions – including the British Medical Association and the Royal College of Nursing – as “potentially disastrous”.

But Mr Cameron insisted that change was essential.

“Every year without modernisation the costs of our public services escalate. Demand rises, the chains of commands can grow, costs may go up, inefficiencies become more entrenched.

“Pretending that there is some ‘easy option’ of sticking with the status quo and hoping that a little bit of extra money will smooth over the challenges is a complete fiction.

“We need modernisation, on both sides of the equation. Modernisation to do something about the demand for healthcare, which is about public health. And modernisation to make the supply of healthcare more efficient, which is about opening up the system, being competitive and cutting out waste and bureaucracy.

“Put another way: it’s not that we can’t afford to modernise; it’s that we can’t afford not to modernise.”

With the Government also set to publish details of its school reforms next week, Mr Cameron cited the experience of Tony Blair, who found that delaying public service reform simply resulted in “institutional inertia” against change.

He acknowledged that in the past the Conservatives had not always shown sufficient respect for those who worked in public services, but insisted he would “revere, cherish and reward” an ethos of public service.

“I believe previous Conservative governments had some really good ideas about introducing choice and competition to health and education – so people were in the driving seat. But there was insufficient respect for the ethos of public services – and public service,” he said.

“The impression was given that there was a clear dividing line running through our economy, with the wealth creators of the private sector on one side paying for the wealth consumers of the public sector on the other.

“This analysis was – and still is – much too simplistic. Public sector employees don’t just provide a great public service – they contribute directly to wealth creation.”

He denied he was planning “a kind of public service version of a laissez-faire economic policy” with the Government’s reforms for schools and hospitals, “where winners are created at the expense of those who get left behind”.

“The state has a hugely important responsibility to ensure clear, basic standards are met, the rights of users are maintained and independent inspection is carried out in our public services and we are in no way abrogating that,” he said.

The Prime Minister also rejected suggestions that the Government was trying to do “too much at once” in pushing through change.

“Every year we delay, every year without improving our schools is another year of children let down, another year our health outcomes lag behind the rest of Europe, another year that trust and confidence in law and order erodes,” he said.

“These reforms aren’t about theory or ideology – they are about people’s lives. Your lives, the lives of the people you and I care most about – our children, our families and our friends. So I have to say to people: if not now, then when? We should not put this off any longer.”

Mr Cameron also explained comments in which he appeared to describe the NHS as a second rate National Health Service as a slip of the tongue.

His slip-up came during a radio interview this morning on BBC Radio 4′s Today programme.

Asked if he would apologise for using the term, Mr Cameron said: “I think if you listen to the interview, I immediately said we shouldn’t settle for second best and that is exactly what I meant to say.

“I speak often quickly, I don’t just have a pre-arranged order of saying things and sometimes you can get a little word out of place and I immediately said, if you listen to the clip, we shouldn’t settle for second best, that was the point I was making.”

To widespread guffaws from the assembled media, he added: “We shouldn’t settle for second best is what I meant, it’s largely what I said, if you skip over a quick word in the middle.”

In a letter to The Times today ahead of Wednesday’s publication of the Health and Social Care Bill, the heads of six health unions expressed their “extreme concerns” about plans to create greater commercial competition between the NHS and private companies within the health service.

The signatories, including BMA chairman Hamish Meldrum, RCN chief executive Peter Carter and the heads of health for the Unison and Unite unions, said: “There is clear evidence that price competition in healthcare is damaging.”

It follows a report by the NHS Confederation which acknowledged the potential benefits of the changes, which will give GPs power over commissioning treatment, but warned they were “extraordinarily risky” at a time when the NHS is facing its toughest financial constraints for a decade.

From: http://www.independent.co.uk/we-cannot-afford-not-to-reform-nhs-says-david-cameron