Health secretary Andrew Lansley blocked Norman Lamb from becoming a minister in his department, the Guardian is reporting after a weekend in which the Liberal Democrat emerged as a high-profile critic of the latest NHS reforms.

There was considerable surprise when Lamb failed to secure a ministerial post in the coalition government after last May’s general election. He became a government whip and Deputy Prime Minister Nick Clegg’s political advisor instead.

Lamb was seen as well informed about health and published his own manifesto for change – ‘The NHS: a Liberal blueprint’ – in the run up to the election.

Today, the Guardian claims that Lamb and Lansley had “an almighty falling out” over the question of funding long term care for the elderly. As a result, the paper says Lansley stopped Lamb winning the social care minister’s job that went instead to Paul Burstow.

A number of papers reported this weekend that Lamb has threatened to resign his advisor post because the scale and pace of Lansley’s reforms. He also warned that his party’s MPs and peers would be unable to support the Health and Social Care Bill if their concerns were not met.

In an article for LibDemVoice this spring, Lamb said he wanted to "strengthen" the reforms, so that they "protect everything that is good about the NHS even as it is brought up to date."

He added: "We must ensure there is proper accountability and that the principles of good governance apply to all commissioning decisions. 

"Competition is not an end in itself and it cannot trump the importance of co-operation and collaboration. Cherry picking by private providers must not happen."

He also called for integration between health and social care to improve care for people with long term conditions and address the challenges of an ageing population.

Lamb wants to see a slower pace of change, with the April 2013 deadline for commissioning to be transferred to GP commissioning consortia abandoned in favour of a more “evolutionary” approach.

He also wants GPs to be able to opt into consortia and for the clusters of primary care trusts that must be in place by June to be retained to performance manage them.

Lansley was forced to announce last week that the government would take advantage of a “pause” in the passage of the Bill to “listen” to criticism of the changes, which will also inject more competition into the provider market.

Unease about the Bill at the Lib Dem spring conference was a factor behind the decision to pause, along with concern from think-tanks and unions about the proposals.

The Royal College of Nursing said this morning that the requirement for the NHS to save £20 billion over the next four years to meet the gap between essentially flat funding and rising demand and costs was leading to massive job losses and cuts to services.

The RCN, which is holding its annual conference in Liverpool, said Department of Health claims that efficiencies can be made through the Quality, Innovation, Productivity and Prevention Agenda, without hitting “frontline” care were not being realised on the ground.

“While we are in an interim phase, with new structures taking shape, we are seeing many patient services vanish, which we fear may simply disappear forever,” said RCN chief executive Dr Peter Carter.

Lamb paid close attention to NHS IT when he held the shadow health brief for his party. His manifesto called for new ways of working to be introduced, but for key planks of the National Programme for IT in the NHS to be scrapped.

He wanted the abolition of NHS Connecting for Health, the end of the National Care Records Service, and for Choose and Book to revert to being a simple online booking system.