By Alex Stevenson
Further amendments to the health and social care bill appear a real possibility as the coalition moves closer to splitting over NHS reform.
Deputy prime minister Nick Clegg came under pressure from Liberal Democrat backbenchers concerned that the legislation continues to place undue emphasis on competition in the health service.
MPs are debating the bill in the Commons for the next two days. Mr Clegg is believed to have sought his party's backing by acknowledging that the proposals could be amended when the bill is sent for debate in the Lords, the Guardian newspaper reported.
At least one Lib Dem, Andrew George, is expected to rebel. Others could abstain, making the issue one of major concern for the coalition's managers.
The Department of Health has already significantly watered down the proposals, after an unprecedented 'listening pause' earlier this year.
Health secretary Andrew Lansley is thought to be determined to avoid any further amendments to the health and social care bill.
Continued opposition from within the NHS poses a major obstacle, however. Last week the British Medical Association, which represents doctors in the NHS, called for the legislation to be withdrawn or substantially changed.
Today health thinktank the King's Fund added its voice to the chorus of criticism with a briefing paper demanding changes to the way hospital services are organised.
It called for responsibility for driving through changes to be clarified, said minimum quality standards based on clinical evidence are needed and suggested removing the secretary of state from the reconfiguration process to 'depoliticise' it.
"Politicians have an important and legitimate interest in how health care is provided locally but too often act as a barrier, rather than facilitating the honest dialogue needed with the public," deputy director of policy Candace Imison said.
"I hope the proposals we have published today spark a debate about how to improve the current decision-making process and provide some practical recommendations for the way forward."