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David Cameron and Ed Miliband clash over NHS reform in PMQs

Miliband tells Cameron to 'stop wasting millions and drop the bill' while Tory leader retorts that Miliband is an opportunist

David Cameron delivered a passionate defence of the government's health reforms in the face of a challenge by Ed Miliband to "stop wasting millions and drop his bill".

The prime minister made it clear his government intended to put the health and social care bill on to the statute book despite growing opposition within the NHS and the Conservative party.

Cameron cast the battle over the NHS shakeup as one between a bureaucrat-run NHS and a doctor-run NHS, insisting that the reforms were stripping billions of pounds in bureaucracy to "plough back" into patient care, and he attacked Labour's refusal to fund increases in the NHS budget.

"They are not in favour of the money, they are not in favour of reform, they are just a bunch of opportunists," Cameron told the Commons.

The premier also rallied to the defence of his beleaguered health secretary, Andrew Lansley, after a No 10 insider was quoted as saying he should be "taken out and shot", raising doubts about his future in the cabinet.

The prime minister and the Labour leader clashed at prime minister's question time on the day that the health and social care bill returns to the Lords for its report stage, where it is tipped to face staunch opposition from sections of the second chamber. In a heated exchange, Miliband told Cameron that "in his hearts of hearts" the prime minister knew that the bill was "a complete disaster", and he cited opposition to the reforms from a long list of health care unions and associations.

"That's why his aides are saying the health secretary should be taken out and shot," he said. "Because they know it's a disaster. The reality about this bill is this: the doctors know it's bad for the NHS, the nurses know it's bad for the NHS, and patients know it's bad for the NHS. Every day he fights for this bill, every day trust in him on the NHS ebbs away and every day it becomes clearer the health service is not safe in his hands."

Picking up on the Labour leader's comments on his Tory cabinet colleague, sitting some distance away on the frontbenches, Cameron quipped: "I've got to tell him the career prospects of my honourable friends are a lot better than his."

As the two leaders traded verbal blows, Miliband said Cameron was unable to defend a pre-election manifesto promise that there would be no more top-down reorganisation, and was failing to listen to the clamour of opposition from healthcare professionals. "Now you say you know better than the nurses, better than the doctors, better than the midwives, better than the Patients Association, people who, day in, day out, rely on and devote their lives to the health service," said Miliband. "This is a matter of trust in the prime minister. Can you honestly look people in the health service in the eye and say you have kept your promise of no more top-down reorganisations?"

Cameron failed to respond directly, saying instead that the reforms were taking out £4.5bn of bureaucracy from the system that would be "ploughed into patient care".

"Now if you don't support the reforms, you won't see that money going into operations, doctors, nurses, hospitals, healthcare assistants. That is what is actually happening in the NHS."

He said 95% of the country was covered by general practitioners already implementing the government's reforms.

"Just today, 50 foundation trusts have written to the newspapers in support of our reforms and objecting to what Labour are proposing."

Over the last 18 months, 100,000 more patients were treated every month, there were 4,000 extra doctors, the number of hospital-acquired infections was down and there had been a 94% reduction in the number of patients in mixed-sex wards, the prime minister said. "That is what's happening because you have got a combination of money going in and reform."

The prime minister is to undertake a series of NHS events next week, and is said to be confident that opposition to the bill in the Lords will be overcome.

Lord Owen, the former SDP leader, is among those most opposed to the bill. He took the unusual step of suggesting on his blog that NHS staff had been misled into believing Tory election guarantees on the NHS because Cameron's late son Ivan, who died in 2009, had been disabled.

Owen wrote: "David Cameron should remember the words he spoke about the NHS during the election. Most of those who work in the health service were aware of his own late son's illness and felt that when he spoke about the NHS not having any more top-down reorganisations, he carried the conviction of someone who had real experience of what the NHS represented in British life."

Cameron appeared to have these criticisms in mind when he told MPs: "I care passionately about the NHS, not least because of what it has done for my family and because of the amazing service that I have received. I want to see that excellent service implemented for everyone and that means two things: it means we have got to put more money into the NHS, and we are putting the money in, but it also means we have got to reform the NHS."

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