MPs have backed health secretary Andrew Lansley's controversial Health Bill with a majority of 86, voting 321 to 235 in support of the plans at a second reading in parliament last night.

Despite its early success, however, proposals for the radical overhaul of the National Health Service are still under intense debate, and the government spent much of yesterday defending its vision. 

Speaking to BBC One's Breakfast programme, the health secretary sought to reassure the public that his plans do not amount to privatisation of the NHS, stressing that it will stay true to its founding principle of 'free at the point of use', but adding that it will be "a good thing if patients and their GPs are able to choose between different providers".

And writing in The Times, the Prime Minister warned that because of the growing number of people needing healthcare and the rising costs of drugs the NHS is heading for crisis if it fails to modernise. “Already our health outcomes lag behind the best in Europe. Without modernisation, the principle we all hold dear – that the NHS is free to all who need it, when they need it – will become unaffordable,” he said.

Under proposals laid out in the Health Bill, GPs will gain access to around 80% of the budget for commissioning, while all primary care trusts and strategic health authorities are up for the chop, making way for a new body, the NHS Commissioning Board, that will watch spending decisions. Elsewhere, there are plans to develops Monitor, the body that currently regulates NHS foundation trusts, into an economic regulator to oversee aspects of access and competition in the NHS, as well as strengthen the role of the Care Quality Commission.

The government argues that this will help create a health service that is more patient-centred, free from bureaucracy and political interference, and more efficient, helping to save around £12 billion by 2020.

But criticism - primarily over the scale and pace of the changes - is strong. Speaking in the House of Commons last night, David Miliband described Lansley's plans as "poison pills" for the health, while others argued that the reforms are unnecessary and pose a danger of breaking up the NHS.

There is also much doubt within the healthcare profession. The British Medical Association has warned that ploughing ahead with the changes as they stand is "a massive gamble", while a poll of GPs commissioned by UNISON showed that just 27% support using private companies to provide NHS services, a central theme of the government's plans.

Little support

"The fact is there is very little support for this Bill from anywhere. Many GPs are opposed to it, as are patients, NHS staff, clinicians, charities, think tanks, MPs and unions. Lansley's vanity project is undemocratic, unaffordable and unnecessary", said Dave Prentis, General Secretary of UNISON. "The Government should step back from the brink and pronounce this Bill DOA - Dead on Arrival".

A similar picture was painted by a poll of (1,800) GPs commissioned by the Royal College of General Practitioners, which showed that over 50% disagree that the envisaged model of GP commissioning will create a patient-led NHS. And more than 70% either disagree or strongly-disagree that an ‘Any Willing Provider’ concept will improve healthcare outcomes.

"Our members are telling us that they are worried about the pace at which these reforms are being implemented, the danger of fragmentation of services, and the emphasis on competition, and they are not sure whether the proposals really will have the positive impact on patient care that is intended," noted RCGP Chair Clare Gerada.