LONDON A mishandled reform of the health system has set doctors and health unions against the government over fears that plans to boost access for private companies will destabilise the cherished service.
The reforms include sacking thousands of health administrators and putting family doctors in charge of spending 60 billion pounds of the NHS budget in a turnaround so large that the service's chief executive says it can be seen "from outer space."
Ministers say concerns are unfounded, but medics are so worried they have urged peers in the Lords to throw out proposals for a complex reorganisation of England's National Health Service (NHS) in a vote on Wednesday.
"The (Health and Social Care) Bill as it currently stands poses an unacceptably high risk to the NHS," the doctor's union the British Medical Association told members of the Lords.
The controversy threatens to undermine Prime Minister David Cameron's attempts to recast his Conservative party as a friend to the NHS after years of voter mistrust.
Opponents say the government has no mandate for the changes it wants to bring to the health service, a vast organisation founded in 1948 that is Europe's biggest employer and has an annual budget of over 100 billion pounds.
They said the proposals were not included in Conservative manifesto pledges ahead of the 2010 election that brought the party to power in coalition with the smaller Liberal Democrats.
"People did not expect, did not vote for and do not want these changes. The government was not elected to do this. They do not have the electorate's mandate," Labour politician Baroness Thornton said at the opening of two days of debate on Tuesday.
If the Lords reject the bill the government would either have to abandon its plans altogether or restart the legislation from scratch next year, adding further hold-ups to the already delayed reforms.
Health Secretary Andrew Lansley accuses opposition politicians and unions of spreading "misinterpretation, misinformation and misrepresentation" about his proposals to improve efficiency and quality of care.
The government has ring-fenced the health service from steep spending cuts in other state departments to reduce a record national budget deficit.
But the NHS remains under financial pressure on a flat budget as it tries to find 20 billion pounds of efficiency savings to pay for the rising healthcare needs of an ageing population and patients' demands for expensive new treatments.
The government has revised the plans once this summer, submitting more than a 1,000 amendments to the legislation in a humiliating climb-down after failing to convince the medical profession its proposals were workable.
But doubts remain and hundreds of leading clinicians have signed letters to newspapers calling for a rethink on the plans, while members of the coalition's Liberal Democrats are threatening to rebel over the legislation.
Wider public concern over the plans has seen marches in defence of the NHS and on Sunday more than 2,000 protesters blocked Westminster Bridge next to the parliament buildings.
Even private health companies -- seen by some as beneficiaries from the changes -- have joined the criticism, saying the government was naive to think it could push through reforms dependent on the support of the medical profession.
"The reaction to the bill and the way it has been managed politically ... has been such that the likely involvement of the private sector is at best static at the moment," said Matt James, of the Private Hospitals Alliance.
(Reporting by Tim Castle; Editing by Michael Roddy)