The Department of Health has expressed its “disappointment” with the decision of two royal medical colleges to announce their opposition to the Health and Social Care Bill.

Both the Royal College of Nursing and the Royal College of Midwives have come out against the bill and are calling for it to be withdrawn.

The decision follows the British Medical Association’s move in December to oppose the totality of health secretary Andrew Lansley’s reforms, which were first set out in the ‘Liberating the NHS’ white paper more than 18 months ago.

The DH said the colleges’ moves were disappointing. “During the course of the past 12 months we have been working with nursing groups to shape our plans for a modern NHS.

"For example, nurses will be represented on local clinical commissioning groups,” it said in a statement.

The statement also cited Prime Minister David Cameron’s recent announcement about changes to nursing practices as a reason for the RCN and RCM to support the reforms.

“Just two weeks ago, the Prime Minister set out plans – welcomed by the RCN – to get rid of red tape so that nurses have more time to spend with their patients.”

A DH spokesperson accused the colleges of conflating their members’ concerns about pay, pensions and the need for the NHS to deliver significant savings, with issues about the bill.

He insisted the reforms were needed to “empower doctors, nurses, and other frontline healthcare workers across the NHS to take charge of improving care.”

David Cameron told Parliament yesterday that it would not be possible to deliver the ‘Nicholson challenge’ – for the NHS to deliver efficiency savings of £20 billion over four years – without such reforms.

“To argue just that the NHS simply needs money and not reform, I do not believe is right,” he said in a noisy Prime Minister’s Questions, that otherwise focused on the UK’s rising unemployment figures.

However, a detailed briefing paper issued by the RCN to explain why it is opposing the bill, says the ‘Nicholson challenge’ is presenting staff with “monumental difficulties” and the reforms are adding to the pain.

“Dealing with such significant cuts to services and staff members would be difficult at any time. Having to deal with it during a programme of dramatic and distracting reform makes the job virtually impossible,” the college said in its own statement.

The RCN paper goes on to say that it is not seeing evidence of intelligent, well thought out service redesign and reconfiguration, and that the DH’s move to get nurses onto emerging CCGs is not being followed through on the ground.

Like the BMA, it also raises concerns about the government’s commitment to introducing more competition to the NHS.

It says that although the government has changed the proposed role of Monitor from promoting competition to keeping an eye on anti-competitive behaviour, the changes do not go far enough.

In another development this morning, the Guardian and the Telegraph reported that Monitor plans to ask credit ratings agencies, such as Standard and Poor’s, to rate NHS foundation trusts for credit-worthiness.

The ratings agencies have been heavily criticised for failing to spot problems at major companies, such as Enron, and for their role in the current banking crisis.

Meanwhile, the RCM’s chief executive, Cathy Warwick, said the government has not shown that drastic changes to the structure of the NHS are necessary.

“They have failed to present evidence that the upheaval will result in an improvement in services to the people of England…

"Breaking up what we have, embracing the private sector, and injecting full-blown competition and market forces is not what the NHS needs or what health professionals and patients want.”

Warwick said the RCM supports the general push towards clinically-led commissioning, greater engagement of service users in their care, and more integrated services, but this could be achieved without a “divisive and costly bill."

The UK’s largest union, Unison, has supported the new wave of opposition and called for the bill’s withdrawal. It said the bill will lead to fragmentation, instability and inequity in the NHS.

“It is wasting billions of taxpayers’ money on pointless bureaucracy, as health workers lose their jobs, waiting lists grow and operations are cancelled.”