����ý

Labour leader Ed Miliband has told David Cameron he risks making NHS reform "his poll tax" - in noisy Commons clashes over the health bill.

Mr Miliband repeatedly accused the PM of refusing to listen to medics' concerns about the controversial bill.

But the government defeated, by a majority of 53 votes, a Labour bid to make it release an internal register of risks linked to the bill.

Mr Cameron said Labour refused to publish a register when in power.

The two leaders clashed at Prime Minister's Questions, ahead of the Labour-led debate calling for the publication of the government's risk assessment of the impact of the NHS shake-up in England.

Some 246 MPs voted for Labour's motion, compared with 299 who voted against following the Commons debate.

Four Lib Dem MPs - Andrew George, Mike Hancock, Greg Mulholland and John Pugh - voted with Labour and against the government.

'Not fit'

The controversial has passed through its Commons stages but has been amended several times by the House of Lords.

Crossbencher Lord Owen is expected to put down an amendment to the bill which would delay its passage through Parliament until after a Freedom of Information ruling on the "transition risk register" on 5 and 6 March.

In the Commons, Mr Cameron said Labour frontbencher Andy Burnham had blocked the publication of a risk register in September 2009 - when he was health secretary.

Mr Cameron said it showed Labour "absolutely revealed as a bunch of rank opportunists, not fit to run opposition and not fit for government".

But Mr Miliband accused the PM of having excluded the "vast majority" of health workers from a "ridiculous summit" on the Health and Social Care Bill on Monday.

Having previously said he wanted to listen to NHS workers "now he can't even be in the same room as the doctors and nurses" - suggesting he had "lost the confidence of those who work in the NHS".

He told the PM "nobody believes him and nobody trusts him on the health service" and claimed the bill had become a "symbol of his arrogance".

Referring to the hugely controversial policy seen as helping hasten the end of Margaret Thatcher's leadership of the Conservative Party, Mr Miliband added: "This will become his poll tax. He should listen to the public and he should drop this bill."

Lib Dem rebels

The government is appealing against a Freedom of Information ruling that it should be published in the public interest.

Labour chose to use its opposition day debate to demand that the government "respect" the information commissioner's ruling and publish the report.

The vote is not binding but does increase pressure on the government.

An on the same issue has been signed by 15 Lib Dem MPs, including Duncan Hames - an aide to Energy Secretary Ed Davey. However, only four of the signatories chose to vote against the government.

Shadow health secretary Mr Burnham told MPs there had been "crucial differences" between the document whose publication he had blocked in 2009 - the strategic risk register - and the one Labour was now pressing the government to publish.

He said he had not initiated what he described as the biggest ever top-down re-organisation of the NHS at a time of its biggest ever financial challenge - and the information commissioner had not ruled in 2009 that the paper should be published.

Health Secretary Andrew Lansley has said it would be "completely misleading" to publish the register, which was put together before changes were made to the bill and had been intended as an "internal mechanism".

Past requests

In the Commons he quoted back Mr Burnham's own words from 2007, when he was a health minister, following a similar request for a risk register to be published - when Mr Burnham said that it would "be likely to reduce the detail and utility of its contents" which would "inhibit the free and frank exchange of views about significant risks".

Mr Burnham repeated that it was not a "comparable situation" as it had referred to a different document.

He claimed regional and local risk registers, which have been published, were "appalling and shocking".

Among them was a warning by South Central Strategic Health Authority, which said "the pace and scale of reform, coupled with savings achieved through cost reduction rather than real service redesign could adversely impact on safety and quality".

One of the Lib Dem rebels, Andrew George, said he acknowledged that if the register was published it was "unlikely to change a single mind on the issue".

But he said it was better not to take on the biggest reorganisation ever of the NHS "in the dark".

The bill has also been criticised by various bodies representing healthcare professionals.

'Delivering reform'

Lib Dem activists are preparing an emergency motion for their party's spring conference next month, urging the party to work towards defeating the bill, amid reports that grass roots discontent on the issue is now greater than that over student tuition fees in 2010.

But Mr Cameron said on Wednesday the bill would "abolish the bureaucracy that has been holding the NHS back".

He argues reform is needed to deal with the challenges of an ageing population and the rising costs of medical treatments and long-term conditions.

Accusing Labour of opposing changes it had once backed, he said: "You don't save the NHS by opposing reform, you save the NHS by delivering reform."

The ����ý's political editor Nick Robinson said that while both coalition partners were insisting the bill would continue, there were clear differences in tone from the two sides about the possibility of further concessions.