The coalition is now split over national health policy

NHS reform becomes first public division as Lib Dem conference votes in favour of radical rewrite of

Controversial proposals to reform the National Health Service in England has become the first public split on policy between the two coalition parties, after the Liberal Democrat spring conference voted overwhelmingly in favour of an extensive rewrite of the bill.

While there have been numerous backbench revolts on certain issues, such as tuition fees, and areas in which the parties have codified their disagreement, such as voting reform, this is the first public division on policy.

Nick Clegg, who said yesterday he was "very relaxed and very positive" about the NHS debate, narrowly averted defeat by accepting two "rebel" amendments when it became obvious that they were going to pass.

The two amendments centre on limiting the role of the private sector in the NHS. The party votes for banning GP consortiums from taking decisions in private about spending NHS money, totally ruling out any competition based on price, banning private companies from taking over commissioning, allowing private health providers in only when it will not damage existing NHS services, and ensuring the role of local government in the consortiums.

This vote is a major development: it means that Clegg's party is formally committed to changing the Health Bill. Evan Harris, the former Oxford MP campaigning on the motion, said that the party expected Clegg and the health minister Paul Burstow to be bound by the vote. In a clear challenge to the leadership, Evans said: "We expect Liberal Democrats in government to follow what we overwhelmingly vote for."

This will pose problems for Clegg with his Conservative cabinet colleagues, as the proposed changes will not beaccepted happily by the Health Secretary, Andrew Lansley (who has also attracted the anger of doctors). Indeed, the whole bill – which proposes giving control of 80 per cent of the NHS budget to GP consortiums – is underpinned by a market-based philosophy.

This opens up an easy fault line for Labour, which can exploit the motion passed today by proposing amendments to the bill and challenging Lib Dem MPs to stay consistent with the decisions passed today and vote against the government.

Samira Shackle is a freelance journalist, who tweets @samirashackle. She was formerly a staff writer for the New Statesman.

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Lord Geoffrey Howe dies, age 88

Howe was Margaret Thatcher's longest serving Cabinet minister – and the man credited with precipitating her downfall.

The former Conservative chancellor Lord Howe, a key figure in the Thatcher government, has died of a suspected heart attack, his family has said. He was 88.

Geoffrey Howe was the longest-serving member of Margaret Thatcher's Cabinet, playing a key role in both her government and her downfall. Born in Port Talbot in 1926, he began his career as a lawyer, and was first elected to parliament in 1964, but lost his seat just 18 months later.

Returning as MP for Reigate in the Conservative election victory of 1970, he served in the government of Edward Heath, first as Solicitor General for England & Wales, then as a Minister of State for Trade. When Margaret Thatcher became opposition leader in 1975, she named Howe as her shadow chancellor.

He retained this brief when the party returned to government in 1979. In the controversial budget of 1981, he outlined a radical monetarist programme, abandoning then-mainstream economic thinking by attempting to rapidly tackle the deficit at a time of recession and unemployment. Following the 1983 election, he was appointed as foreign secretary, in which post he negotiated the return of Hong Kong to China.

In 1989, Thatcher demoted Howe to the position of leader of the house and deputy prime minister. And on 1 November 1990, following disagreements over Britain's relationship with Europe, he resigned from the Cabinet altogether. 

Twelve days later, in a powerful speech explaining his resignation, he attacked the prime minister's attitude to Brussels, and called on his former colleagues to "consider their own response to the tragic conflict of loyalties with which I have myself wrestled for perhaps too long".

Labour Chancellor Denis Healey once described an attack from Howe as "like being savaged by a dead sheep" - but his resignation speech is widely credited for triggering the process that led to Thatcher's downfall. Nine days later, her premiership was over.

Howe retired from the Commons in 1992, and was made a life peer as Baron Howe of Aberavon. He later said that his resignation speech "was not intended as a challenge, it was intended as a way of summarising the importance of Europe". 

Nonetheless, he added: "I am sure that, without [Thatcher's] resignation, we would not have won the 1992 election... If there had been a Labour government from 1992 onwards, New Labour would never have been born."

Jonn Elledge is the editor of the New Statesman's sister site CityMetric. He is on Twitter, far too much, as @JonnElledge.