Concessions signal Cameron gamble on health shake-up

Mr Cameron admitted his Government had “learnt a lot” from the storm of criticism that had engulfed the proposals and promised there would be no “sell-off” of services.

But he also insisted it had been right to “pause” the legislation and the debate had convinced people that the NHS did need radical reform to avoid “buckling” under increasing demands.

Labour leader Ed Miliband dismissed the intervention as evidence of the “chaos and confusion” the coalition was wreaking on the health service.

The Government is expected to unveil full details of its reworked health plans next week after the outcome of a consultation exercise is published.

However, Mr Cameron pre-empted the results by indicating that the overhaul would include involving hospital doctors and nurses – not just GPs – in spending decisions, creating “clinical senates” to bring together healthcare professionals to oversee the integration of care over wide areas and giving the health regulator Monitor a duty to promote integration.

He also sought to reassure critics that there would be no dogmatic pursuit of competition, that private firms would not be able to “cherry pick” the most lucrative services and that targets on waiting times would be kept.

As part of five personal “guarantees” for voters to test him against, Mr Cameron pledged there would be no cuts in NHS spending and waiting times would be kept low.

The British Medical Association described Mr Cameron’s comments as “a significant step in the right direction”.

But Royal College of Midwives general secretary Cathy Warwick said: “David Cameron has not honoured his pre-election pledge to recruit 3,000 more midwives, so how can we trust him not to break his promise on these pledges?”