By Alex Stevenson Follow @alex__stevenson
Two influential groups representing nurses and midwives have moved to oppose the government's NHS reforms outright, in another big setback for the coalition.
Ministers had hoped to placate opposition to the health and social care bill with their listening pause last year, but concerns have continued over the legislation's bid to impose a market dynamic on the NHS.
Today the Royal College of Nursing (RCN) and the Royal College of Midwives (RCM) have called on the government to scrap the bill completely.
"The RCN has been on record as saying that withdrawing the bill would create confusion and turmoil," chief executive and general secretary Peter Carter said.
"However, on the ground, we believe that the turmoil of proceeding with these reforms is now greater than the turmoil of stopping them.
"The sheer scale of member concerns, which have been building over recent weeks, has led us to conclude that the consequences of the bill may be entirely different from the principles which were originally set out."
It believes the government's proposals are unlikely to achieve the principles which were originally set out.
But it is plans to increase the cap for private income for NHS hospitals to 49% which appear to have been decisive, with Dr Carter saying that members fear "the needs of the market could come ahead of the needs of patients".
He added: "While we are not opposed to the principle of competition in the NHS, recent developments have shown that the balance between competition and quality has become skewed."
The RCM said it wanted ministers to walk away from the legislation because they had failed to present sufficient evidence that the "upheaval" would lead to significant changes.
The all-party parliamentary group on primary care and public health published a report yesterday warning that the expected bill for the transition is up to £3 billion.
The RCM said the high cost was especially painful at a time when the Department of Health has to achieve £20 billion of efficiency savings.
"Breaking up what we have, embracing the private sector, and injecting full-blown competition and market forces is not what the NHS needs or what health professionals and patients want," chief executive Cathy Warwick said.
"We join the growing chorus of voices calling for the bill to be withdrawn, and the proposed reforms stopped in their entirety."
The Department of Health said it had made concessions to nursing groups, which it has worked with for the last 12 months, including moves to represent them on local commissioning groups and cut the amount of red tape nurses have to deal with.
A spokesperson said officials were "disappointed" by the RCN and RCM's new position.
"The bill is needed to empower doctors, nurses, and other frontline healthcare workers across the NHS to take charge of improving care," she said.
"We will continue to work with nurses and all other health professionals to ensure that the NHS delivers the best possible care for patients."
But shadow health secretary Andy Burnham said a "professional consensus" was vital for a change on this scale to succeed - and that the RCN and RCM's shift had prevented that from being achieved.
"A year since the bill was introduced it is abundantly clear that the government's plans have failed to build that," he commented.
"It is time to put the NHS first. The government must listen to patients and NHS staff and put this bill out of its misery."