Opposition leader Harriet Harman has clashed with David Cameron over the new government's plans to reform the NHS, including providing GPs with greater budget responsibilities.
During prime minister's questions on Wednesday, Ms Harman demanded answers from Mr Cameron about whether or not his government was being upfront about costs: "The White Paper admits there will be extra cost because of loss of productivity, staff relocation and redundancies.
"Does he stand by what he said just a few months ago about about NHS reorganisation? He said the disruption is terrible, the demoralisation worse, the waste of money inexcusable."
But Mr Cameron responded, "We are not reorganising the bureaucracy, we are scrapping the bureaucracy."
Ms Harman also addressed guarantees of treatment for cancer patients, saying Mr Cameron had "dodged" the issue when he refused to directly confirm if the guarantee would remain in place.
Mr Cameron said: "If a target contributes to good clinical outcomes, it stays. If it doesn't, it goes."
Ms Harman retorted: "He is obviously ditching the guarantee for cancer patients, but he hasn't got the guts to admit it to this House."
However, Health Minister Simon Burns later told BBC Radio 4's The World At One that there were no alterations to the commitment to cancer patients.
Mr Burns said: "The decision on targets was taken on which ones were not clinically justified. It was quite clear that the cancer one was clinically justified and is being kept. There is no question of it going," he said.
Copyright © Press Association 2010
Your comments (terms and conditions apply):
"Good and bad in this change. Hope the GP budget is carefully monitored and all staff get NHS contract and clause put in as spouce shouldn't be allowed to be the manager. Evidence based is better than target based care" - Esh, Hounslow
"Since coming into the NHS in 1979, first of all as a part time domestic, then an auxiliary nurse to RGN, I have seen many changes. At first high standards of cleaning and nursing staff, with sufficient numbers to do the job, only to drop under the Conservatives. Privatisation of cleaning staff meant a reduction in numbers of both cleaners and later on nursing numbers, along with cuts in supplies with not enough soap and towels to wash hands properly, also another common theme was not enough laundry or equipment. The wards became dirty and infection rates rose. With overstretched nurses, training and mentoring of students suffered. Waiting times for operations increased. The only ones who were OK were the ones who could pay for private healthcare. It was Labour that re-invested in the NHS, raised standards; set targets which some do not like but it worked. There has been so much improvement under Labour, and that improvement needs to continue. However I worry we will lose so much of what we have gained. I know we need to reduce the country's deficit, and inefficiency does need to be cut out, including all staff not just the lower ranks. I am willing to do my part with a wage freeze and an increase in pension contributions, but lay off the terms and conditions of the NHS staff who have worked extremely hard and tirelessly" - Christine Cowlard, Surrey
"I am extremely apprehensive about this government that seems to want to abolish the NHS. When Cameron was campaigning, he seemed believable and keen to praise the work of nurses and health visitors. As a student health visitor due to take up a post as a qualified health visitor in September, I wonder what is in store for us. Cameron stated that he valued our role and will increase our number to 4,000 placed in children's centres. Has anybody asked us what we think? To make matters worse, he has now proposed that GPs will have greater powers and will abolish PCTs and SHAs. I am proud to work for a PCT and I would absolutely dread working for a GP who will probably treat me like a practice nurse and expect me to do whatever they want me to do. PCTs at least have policies, procedures and protocols and a job description which helps protect the public. GPs I'm not sure. Furthermore, have they investigated the GPs who have pocketed a lot of NHS which has made them very rich. Who is to say how they will spend the money? I really value my job and feel I do a very important job in supporting mothers and addressing the inequalities in health. As a specialist practitioner, I am autonomous in decisions I make and follow my code of conduct seriously but if I were approaching retirement, I would consider retiring earlier to avoid the oncoming mess!" - Margaret, West Midlands
"I am a practice nurse, and although I am not very optimistic that the quality of patient care given by some of these so-called university-trained nurses will improve, I also think that some NHS service levels cannot possible get any worse. So let us go for change hoping for the better, when patient care will be considered fore and foremost by good comprehensive knowledge-based staff and less bureaucratics. The present government deserves the opportunity to try to repair the damage" - Mary Taylor, London
"Having worked as a nurse in the NHS since 1975, I wholeheartedly agree with the comments made by Zulaika Mittal. Nurses need to get back to basics and provide a quality of care to patients at grass roots level, not via a degree course or classroom. We can be maxi nurses not mini doctors. As a nurse practitioner just completing a degree course to remain in the job I have done for 20 years, I acknowledge some nurses may wish to gain further skills and, of course, research-based evidence is paramount, but if the basic care is lacking to begin with it will not provide patients with a standard they deserve" - Janet Hinton, Ipswich
"I have to agree with much of the above - we do not need another shake up - the last government has improved services and training for staff, we need well-qualified staff. They built and refurbished many many hospitals it's not a patch on the squalor, poor service and long waiting lists (unless you had private insurances) left by the Tories in 1997. Now they are at it again tramping about looking for ways to ditch the NHS services - well watch out folks because having sealed themselves in for 5yrs in office they will do it and all the good work will be undone ... I hope you've got deep pockets, I reckon we are all going to need them - as for me a quick exit looks very tempting" - M Wood, W Midlands
"This is privatisation by the back door, it would have proved interesting reading to hear the nation's response to this white paper in the media prior to the election and do people really recognise the implications of a privatised NHS?" - Louise Baker, Midlands
"With all the proposed changes to GP services I envisage our workload becoming crippling to the already overstretched and underpaid staff. Scrapping PCTs will push their work our way and in no way improve services. It will merely save money for the government. I have had more than enough of changes and am retiring early before they steal my pension as well!" - Anne St Pier, Essex
"Having looked at some of the ideas for reform that the government has put forward, it appears to me that they are far removed from what ordinary people are thinking, they seem to be treating the electorate with contempt. It seems that the government is aiming to privatise the NHS via the 'backdoor'. The more I read the document, the more it appears that the government does not care about improving the nation's health but more about responding to the requirements of private enterprise - Foundation Hospitals or not Foundation Hospitals. When hospitals run into debt from borrowing they will be at the mercy of private companies willing to take them over. If every voter in the country is given a copy of the white paper to read, they would be horrified at what the government is proposing" - Name and address supplied
"Those who work in the NHS like myself, a health visitor, are providing a service now run on goodwill as we continue to be stretched beyond our capacity. We all hope that Mr Cameron does not end up with another Baby P on his hands as a result of what at present seems to be disorganised chaos" - G Cockerham, Leeds
"Having worked in the NHS for 40 years, I have seen the various changes made, most of them totally unnecessary and bureaucratic. What we need are definitely properly trained frontline staff, especially nurses both in primary and secondary care. I have always been against the so-called degree/diploma university-based qualification for nurses. I may sound old-fashioned, but nothing beats our type of training. To do this we need two changes. Firstly, we need to get back to basics where there are teaching hospitals attached to nurses training (not universities). Where hands on approach along with theory was given. That way you get both confident and properly qualified nurses dealing with patients. One can move on to further their skills if needed. Secondly, we need to get rid of all the unnecessary managers and duplication of paper work that has been there in the past few years. Yes! we do need some managers but we have been over saturated with them. They really do not have the skills when it comes to making decisions on how to spend on clinical matters. I sincerely hope that these points are taken into consideration" - Zulaika Mittal, Esher
"It appears little has changed, and the Conservatives cannot be trusted with managing the NHS, this was not in the election manifesto of either the Tories or the Lib Dems, and is a leap in the dark, with possible devastating results for the NHS and those who work in it!" - Chris, Maidstone
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