Published: 09/05/2002, Volume II2, No. 5804 Page 7

The government is expected to try to overturn last week's defeat in the Lords over patient councils, when the NHS Reform Bill returns to the House of Commons. But such a move could spark a revolt by Labour backbenchers in the Commons, or - if the government succeeds - lead to conflict between the Commons and the Lords.

A largely unorganised revolt by backbench Labour MPs cut the government's majority to just 74 last time the NHS Reform Bill was in the Commons, and a bigger rebellion is a possibility if ministers fail to negotiate a compromise.

Members of the Lords last week voted 227 to 136 in favour of an amendment - backed by opposition and cross-bench peers and Labour rebel Lord Rea - establishing patient councils to coordinate trust-based patients' forums across local health economy areas. The vote comes after a lengthy battle over the government's proposed patient and public involvement system.

The vote echoed the debacle over last year's Health and Social Care Act, when the government was forced to abandon clauses that would have abolished community health councils.

But a Department of Health statement suggested ministers were unlikely to concede defeat graciously. 'We expect that in the long run our proposals will be successful, ' it said.

It added: 'As [junior health minister] Lord Hunt said in the debate... we are prepared to amend our proposals in other ways in order to achieve the co-ordination of patients' views at local level that the opposition parties say they want, on the condition that we do not have patients' councils.'

But Lord Hunt's offer was roundly rejected by peers. Lord Clement-Jones, Liberal Democrat health spokesman in the Lords, told HSJ: 'We are just going to play ping pong, ' with the bill sent back and forth between the Commons and the Lords. Peers were 'very determined' after the 'stonking' 91-vote margin last week, he said.

Speaking to HSJ after the Lords' decision, David Hinchliffe, Labour chair of the Commons health committee, said he was 'hoping to have discussions with ministers and whips... to see whether it might be possible [for them] to accept the amendment'.

The Lords' amendment was based on his own proposals for patients' councils - which had been accepted by the government during debate on the Health and Social Care Act, he pointed out.