The House of Lords is to vote on plans that ministers say could kill off the government's health bill for England.
Peers will decide whether to delay the bill, which would give clinicians control of budgets, and refer parts of it to a special select committee.
Health Minister Earl Howe has warned that a hold-up could "prove fatal" to the entire Health and Social Care Bill.
Peers will also vote on an amendment by Labour peer and former GP Lord Rea to block the bill altogether.
He argues it was never a manifesto commitment.
The Health and Social Care Bill would increase competition and put GP-led groups in control of buying care in their areas.
'Health is different'Ministers say the changes are vital to help the NHS cope with the demands of an ageing population, the costs of new drugs and treatments and the impact of lifestyle factors, such as obesity.
They say the bill, which has already been substantially altered following criticism from NHS staff and Liberal Democrat MPs, now has wide support.
But more than 60 leading medical professionals, supported by celebrities including fashion designer Dame Vivienne Westwood and comedian Russell Brand, warned on Tuesday that it was still unpopular.
Health and Social Care Bill
- Jan 2011: Commons First and Second readings. Approved with no rebellions
- Feb - Mar: Commons committee stage, various amendments accepted on competition
- 4 April: Bill "paused" following widespread criticism
- April - June: "Listening exercise" conducted by NHS Future Forum
- June - July: Bill sent back to Commons committee stage. MPs approve further amendments prompted by listening exercise
- 6 - 7 Sep: Commons report stage and Third Reading - approved with four Lib Dem rebels
- Sep: Bill arrives in the Lords
- Christmas? Ministers would like the bill to get royal assent by then but even without further delays, there are still several stages to go through
- April 2013? Further delays notwithstanding, NHS commissioning groups due to take charge of budgets then
Two cross-bench peers - Lords Owen and Hennessy - have tabled an amendment calling for part of the bill to be sent to a special select committee - which allows witnesses to give evidence - for further scrutiny.
They say the bill raises serious constitutional issues, particularly aspects relating to the role of the health secretary in overseeing the NHS and the role of a new body, Monitor, in promoting competition within it.
Lord Owen said a special select committee was the only way of looking at "the complexity of this new relationship we are trying to establish" between patients and clinicians.
"Health is not a public utility," he warned. "Health is different."
Labour peers are expected to back Lord Owen's amendment when the house votes later on Wednesday morning.
Baroness Thornton, who leads for Labour on health in the Lords, said the bill would turn "patient choice into shopping", while health care would become a "traded commodity".
Lord Howe, however, told peers the proposed changes would "liberate the NHS" and improve patient care in England.
In a letter sent to all peers shortly before the debate began, he warned: "[The] potential for slippage in the timetable carries grave implications for the government's ability to achieve royal assent for the bill by the end of the session. The bill cannot be carried over from this session to the next.
"The House must have proper time to examine the bill but the proposal put forward by Lord Owen could result in delay, which could well prove fatal to it."
Source: http://www.bbc.co.uk/go/rss/int/news/-/news/uk-politics-15269207
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