There are fears that the NHS is on an irreversible path towards privatisation after opponents of controversial health service competition rules failed to overturn them.
A Labour move to throw out Section 75 Regulations, which protesters claim open up NHS services to market competition, was defeated in a House of Lords debate on Wednesday by 254 votes to 146, Government majority 108.
Opponents failed despite former cabinet minister Lord Owen warning the rules would leave the NHS "massively changed" and unrecognisable within 20 years.
The British Medical Association (BMA) has said the regulations should be replaced with new rules that "unambiguously reflect Government assurances that commissioners will not be forced to use competition when making their commissioning decisions".
Shadow health minister Lord Hunt of Kings Heath, who led the calls for peers to strike down the regulations, said they could not be in the interests of patients. "Every day up and down the country a market is unfolding in the NHS," he said and warned the interests of patients would be "not first but last" if the regulations went through.
But health minister Earl Howe said the Government had not changed the law relating to competitive tendering "one iota" and the regulations would provide "safeguards".
Speaking after the vote, shadow health secretary Andy Burnham said the NHS was no longer safe in the Prime Minister's hands. He said: "It is sad that in this, the 65th anniversary year of the NHS, the unelected House has voted to undermine its founding principles and plant the free market at the heart of the NHS. David Cameron promised to put GPs in charge, but has instead forced them to carve open the NHS to full competition. He has put the NHS up for sale - without the permission of the British public."
During the debate Lord Hunt warned of the "fragmentation" of NHS services and said the regulations removed the "discretion" of commissioners to decide when to offer services out to tender. "Commissioners can currently look at the needs of the NHS as a whole and make a holistic judgment about who is best placed to deliver a service," he said. "These regulations make it far more difficult for commissioners to take such a whole picture approach."
Lord Howe rejected the idea that the NHS was being opened up to privatisation, telling peers: "Amidst all the many changes the Government has made to NHS commissioning, one area of law that we have not changed one iota is the law relating to competitive tendering. That law has been in place for a number of years, it has been governed by a European directive and as regards the rules that govern NHS procurement these rules usher in nothing new at all."
He said there was "no Government agenda to prioritise NHS services" and "quite the contrary" ministers had introduced a new law preventing commissioners from favouring independent providers.