By Ian Dunt Follow @IanDunt
Nick Clegg has effectively authorised Liberal Democrat peers to dismantle key sections of the NHS reform bill in a bid to appease his grassroots supporters.
The move comes as opponents launch a last-ditch effort to significantly amend the legislation in the Lords this week.
Lib Dem peers are trying to rid the bill of elements pertaining to competition. Party president Tim Farron and Shirley Williams, who led opposition to the bill in the second chamber, have said they are intent on stripping the bill of its provisions for increasing competition in the NHS.
This afternoon, the deputy prime minister gave them his blessing in a joint letter with Baroness Williams.
"Given how precious the NHS is, we want to rule out beyond doubt any threat of a US-style market in the NHS," the pair wrote.
"That is why we want to see changes made to this bill that have been put forward by our Liberal Democrat team in the House of Lords to make sure that the NHS can never be treated like the gas, electricity, or water industry."
They propose curtailing the Competition Commission's influence in the NHS, handing Monitor power to ensure NHS patients are served first and setting up additional safeguards against takeover by private health firms.
Capping the number of private patients in NHS hospitals and creating a requirement for foundation trusts to get permission from governors before carrying out extra private work are also proposed.
The leadership's backing for the proposal could head off calls for the bill to be dropped altogether at the Liberal Democrat spring conference in two weeks. A similar vote last year triggered the 'listening pause' and signalled the start of major problems for the bill.
Labour was unimpressed by the development, however.
"David Cameron is clear: this bill is about competition and turning the NHS into a market. No amount of minor amendments to save face for Nick Clegg is going to change that," shadow health secretary Andy Burnham said.
"Today's talk from the Lib Dems of minor amendments is too little, too late. They will only serve to further complicate a bill already described as a 'confused mess' by a former NHS chief executive."
There will be crunch votes today on conflicts of interest and integration of services – both moments which will be watched closely by ministers for signs of rebellion in the Lords.
Once Lords complete their initial amendments they will pass the legislation back to the Commons. While it is probably too late to stop the legislation, peers can still significantly limit its effects with a series of carefully structured amendments.
Without significant concessions in the Commons, however, the Lords amendments can be voted down by the coalition.
The Royal College of Physicians holds an emergency meeting today to decide whether it believes the bill should be scrapped.
If it votes in favour it will join the ever-growing majority of medical bodies who have condemned the legislation, although its decision will be particularly damaging because it once worked with the government on the reform.
The British Medical Association will also be at the centre of attention, as it toys with the idea of industrial action short of a strike over pension arrangements.
Last night bookies made health secretary Andrew Lansley 5/4 favourite to be the next Cabinet minister to leave his post, amid the continued controversy over the reforms.