Cameron stands firm on NHS changes to 'avoid crisis'
David Cameron has said the NHS in England needs to change to avoid a "future crisis" as he sought to rally support for a controversial shake-up.
Speaking to health staff, the prime minister said the NHS was performing well but faced "enormous financial pressures" as people lived longer.
But he hinted at concessions on plans to give GPs more control over budgets and the private sector a greater role.
Labour said NHS professionals believed the plans were a "complete shambles".
Ministers have promised "substantial" changes to the proposals contained in the Health and Social Care Bill after calling a "pause" to their progress pending the results of a "listening exercise" involving patients, doctors and nurses.
Amid unease in Lib Dem ranks, Deputy Prime Minister Nick Clegg has warned his party will block the proposals unless they are altered.
In a speech at a London hospital, in which he drew on his family's experience of the NHS, Mr Cameron said he "loved the NHS" and it was the "most important" institution in the country for his family.
But while pledging "never to take risks" with the health service's core principles, he said there were growing problems due to too much waste, inflexibility and top-down control.
"It is because I love the NHS so much that I want to change it," he said. "It needs to change to make it work better today and it needs to change to avoid a crisis tomorrow."
Increased life expectancy, the rising cost of drugs and public health challenges - such as growing levels of obesity - could leave the NHS facing a multi-billion pound funding shortfall unless action was taken, he added, while wide disparities of quality of service and of health outcomes need to be addressed.
"Sticking with the status quo and hoping we can get by with a bit more money is simply not a serious option," he said.
"There's only one option we've got and that is to change and modernise the NHS, to make it more efficient and more effective and above all, more focused on prevention, on health, not just sickness. We save the NHS by changing it."
Mr Cameron stressed that the plans, drawn up by Health Secretary Andrew Lansley, would not be abandoned and sought to quash opposition claims that they could lead to full privatisation of the NHS, saying there would be "no competition for competition's sake".
But he said the changes needed "to be delivered in the right way" and he wanted doctors and nurses "with, not against" the proposals.
"We are listening and we will make substantive concessions to the reforms based on what we hear," he said, adding that he would be "held accountable" for any amendments to the proposals.
Among these, he promised a role for consultants, nurses and other professionals - not merely GPs - in the commissioning of care and that there were would be no "cherry picking" of services and patients by the private sector.
But BBC Health Correspondent Branwen Jeffreys said there were no further details about limits on the role of the private sector - which unions are demanding.
'Not thought through'
Critics of the proposals say they were not included in the government's coalition agreement and attempting a major re-organisation when the NHS having to find billions in efficiency savings is foolhardy.
Ahead of the speech, the chairman of the doctors' union, the British Medical Association, called for major alterations to the government's plans.
"We believe that the bill has to be radically changed and probably so radically that, in essence, it would really be a different bill," Dr Hamish Meldrum told BBC Radio Four's Today programme.
"It would be better to withdraw this bill and produce a new one. Nobody is saying there needs to be no change in the NHS, but the sort of change that is contemplated with the details of this bill are not the right changes."
Labour have have questioned whether the proposed legislation in its original form can continue.
"All the evidence is that the prime minister is going to press ahead with a bill that nobody voted for, is not properly thought through, and which NHS staff have been telling me are a complete shambles," opposition leader Ed Miliband said.
"The problem with this bill is that it is expensive, bureaucratic, and it is not properly thought through."
And shadow health secretary John Healey said the government's proposals needed a "root and branch" rethink.
"He (David Cameron) made the case for change in the NHS but not the changes in his bill."