Hello and welcome to today's NHS live blog.

The House of Lords is due to vote today on two amendments that could wreck the government's controversial health and social care bill.

Lord Rea has tabled an amendment that would deny the bill a second reading. Rea said in the Lords yesterday that the plans had not been in either the Lib Dem or Tory manifestos, or the coalition agreement, so peers ought to oppose them.

And Lords Owen and Hennessy have tabled an amendment that would kick the bill into a special select committee, which would delay its progress so much it could fail to get royal assent and fall. Owen and Hennessy want to see the third section of the bill, which deals with competition in the NHS, sent to the select committee, as my colleagues Allegra Stratton and Sarah Boseley explain here.

If all crossbenchers opted to support the Owen-Hennessy amendment, along with all Labour peers, the government could be defeated and forced to endure the bill being funnelled through the Owen-Hennessy special committee.

Under the amendment, the special committee would report back by 19 December, increasing the prospect that the legislation would not be completed by April.

Lord Howe, the Tory health minister, has written to peers warning that such a move could prove "fatal" to the bill.

The health and social care bill abolishes primary care trusts and strategic health authorities, replacing them with consortia and commissioning bodies led by GPs. It also potentially increases the use of private healthcare within the NHS.

Yesterday 85 peers were scheduled to speak in the Lords debate on the bill, with a further 13 due to speak today from 11am. The final speakers, Lords Hunt and Howe, are due to speak about 1pm. Peers will then vote on Rea's amendment, and, if that does not pass, on Owen and Hennessy's.

The Lords session has begun, and the debate on the health and social care bill has restarted.

Lord Campbell of Alloway is up first. He says the reforms in the bill are "urgent" and "requisite" and "there is no way it can be delayed".

Lord (Robert) Winston (left), the scientist and TV presenter, is speaking now. He says key operations are cheaper in the UK than in the US, France and Germany. He defends the Labour government: "The health service was left in a pretty fine state."

He says he feels the health bill is "unnecessary" and "irresponsible".

Lord (Peter) Hennessy, the historian, is speaking now. He is one of the peers tabling the amendment that would send the bill to a special select committee, perhaps killing it off. He says the NHS is a "key ingredient in the way we imagine ourselves".

The "tension that ripples through the bill now before us" comes from the contradiction between its attempts to pay lip service to the original founding principles of the NHS and an attempt to introduce some free-market principles into the health service, Hennessy says.

He does not want the health secretary to "abandon his original role as guarantor" of the health service.

He wants parliament to "rediscover the old device" of a preamble before the bill, setting out the principles of the NHS.

He wants the bill to go to a select committee "not in the spirit of wrecking this bill, but improving it". Lord Owen said something very similar yesterday.

He said Lord Howe's words on the secretary of state's role yesterday were welcome but "jarred" with answers he had given to the constitution select committee.

Lord Beecham says "in overwhelming numbers, doctors, nurses and general practitioners have rejected the bill". He has been deluged with letters about the bill, "of which precisely one has been in support of it". He says it has been drafted to meet ideological, rather than medical, objectives.

He says the health service is "of great utility" but is not a utility, like gas and water. It falls to the Lords to protect it, he says.

As I mentioned yesterday, the pressure group 38 Degrees has been hosting a very successful "save our NHS" petition. It's now got over 140,000 signatures (thanks Masterofpuppets and parrotkeeper in the comments).

Lord (Norman) Fowler, the former Tory minister, says any reform in the NHS "comes up against the implacable opposition of the BMA" and the opposition. He says the argument about the democratic legitimacy of this bill does not hold water; it is legitimate because it has been passed by the House of Commons, the elected house. As for Owen's amendment, Fowler says the normal procedures of the Lords are sufficient to properly examine the bill. He supports the bill because "it explicitly recognises that not everything needs to be run by the health service itself". He says fair competition is recognised as a good thing in every other industry in the country. And introducing some private sector involvement does not mean privatisation, he says.

Labour's Lady Pitkeathley says she is going to speak in favour of a very small part of the bill, the creation of the professional standards authority. But that is the limit of her support; she says she grew up in the Channel Islands, where people had to pay for healthcare and one's level of health was dependent on one's income, implying she fears the bill will lead to such a situation in the UK. She also asks: "Is there anyone who really believes that the mantra of 'no decision about me without me' [one of the government's stated principles for NHS changes] is really going to be facilitated by the bill before us?" She adds: "All my experience shows that structural change does not bring about integration and collaboration."

Giant commercial interests [are] currently circling our NHS … I doubt they would be circling if there was no prospect of profits.

She says the government has "utterly failed" to build a consensus for change.

Lady Finlay of Llandaff, a former president of the Royal Society of Medicine, spoke a little earlier in the debate. She said:

I have kept asking - do we need this bill to bring about the changes to drive up quality of care, improve outcomes and empower the patient voice and decrease layers of bureaucracy? The answer I have consistently had is that the vast majority of the changes can happen without this bill and indeed the most important ones are already happening. I doubt this house will throw out this bill but it must amend it properly.

The crossbench peer warned that changes to the NHS risked being an "ever increasing distraction for clinicians and managers" at a time when they had to save money.

Here is the text of Lord Owen's motion, which peers will vote on at the end of the debate. The amendment adds the following text to the bill:

And that a select committee shall be appointed to examine and make recommendations to the house on the issues raised by the 18th Report of the Constitution Committee, namely the government's and parliament's constitutional responsibilities with regard to the NHS, in particular to clarify (a) the extent to which the secretary of state remains responsible and accountable for the comprehensive health service, and (b) individual ministerial responsibility to parliament, and to report on the extent to which legal accountability to the courts is fragmented; that this house requests that the services of parliamentary counsel be available to the committee; and that the committee shall report no later than 19 December 2011.

I have just been speaking to the Lords information office. If Lord Rea's amendment to deny the bill a second reading fails, Lord Howe will commit the bill to its next stage: committee stage. Lord Owen's amendment would alter the way the committee stage works in this case by sending part of the bill to a special select committee (which some people think could delay it so long it would fail). Peers will vote on Owen's amendment after Howe has committed it for second reading.

Committee stage is usually followed by report stage and third reading in the Lords, after which the bill would go back to the Commons. But if Owen's amendment passes it may get stuck in committee stage and fail to move to its next stage; the bill would then fail to get royal assent by the end of the parliamentary session, and Lord Howe has said this could prove "fatal" to the legislation.

Lord Alderdice, the Lib Dem peer, says the bill needs to get to committee stage to build "the best possible bill". What would happen "if it was just tossed out"? There would be a lack of clarity for people working in the NHS, he says. He says Owen's select committee idea "could drag things out for a considerable period of time". But he tells Howe to make it clear that the health secretary remains the "guarantor" of the NHS.

Archbishop John Sentamu says "Joe and Jane Public" did not vote for the bill. "That's why there is anxiety in the nation."

Lady Scotland, the former Labour attorney general, says it will be difficult to examine the bill in requisite detail on the floor of the house. "That is often done away from the public eye and the public glare so people can say what they genuinely think," she says. So she suggests this would be better done in a select committee, "which we know will have the commitment and the belief of all of us if we give them that opportunity". She supports Owen and Hennessy's amendment.

Labour's Lord Hunt of Kings Heath, speaking for the opposition, says the reform is in "direct contradiction of [David] Cameron's pledge of no top-down reorganisation" and "driving a coach and horse" through the coalition agreement.

Why, when the NHS is facing the challenge of cutting its budget by £20bn, is this reorganisation being foisted on it, Hunt asks.

He runs through Labour's achievements in improving the health service. Why did the coalition not build on Labour's increase of patient choice and decentralisation? He calls the reforms "expensive and bureaucratic".

The Commons amendments to the bill "taken together prove to be of little substance", he says.

For example, he looks at the role of the health secretary under the new legislation: "It is about ministers evading their responsibilities. I would rather be overseen by a minister who is properly accountable to parliament than to a quango whose accountability is somewhat tenuous."

He says there is "real confusion" about the role of Monitor, the economic regulator. "Concerns remain about the extent of competition in the future NHS," he says, quoting the King's Fund. What will be the relationship between Monitor and the Care Quality Commission (CQC)?

At a local level, "the architecture is even more confusing". To accuse Labour of creating layers of administration is "a bit rich", he says. He runs through the various levels of bureaucracy, saying the government has "created a monster, where opportunities for delay and buck-passing will be legion".

Hunt says he will support Owen's motion. He hopes that even at this late stage Lord Howe will say the government will support it.

He mentions the 38 Degrees petition, now at nearly 150,000 signatures. "That is but one small reflection of widespread concern within the community about the NHS."

Tory minister Lord Howe rises to conclude the debate, which he says has been a good one.

He acknowledges that "the investment made by the previous government" has contributed to the quality of the NHS today.

But he says there are variations in quality and outcomes around the country that need to be addressed. And the reforms are intended to make the NHS sustainable, so it is still there in five, 10 or 20 years.

There is growing demand from an ageing and growing population, Howe says. The structure needs to be streamlined.

If he has one criticism for the benches opposite, it is their failure to grasp the scale of the financial challenge faced by the NHS, he says politely.

Howe says he has met "so many" clinicians who back the reforms.

"The NHS needs continual renewal. It has never stood still, and it cannot stand still now."

On the removal of the health secretary's "duty to provide", he says: "There has been concern this means the health secretary's accountability is somewhat diluted. I can reassure noble lords this is not the case."

He adds: "Rather than pretend that somehow the secretary of state is responsible for all clinical decision-making in the NHS. The bill recognises expertise must sit with those closest to patients."

He says in an emergency such as a pandemic the health secretary can take direct control.

But he will make "any necessary amendment" to put it beyond doubt that the secretary of state remains responsible for the NHS, Howe says.

He rejects claims that the bill will lead to an "American-style market free for all". "The bill does not introduce a free market for all. It does not change competition law or widen the scope of competition law. it does introduce a framework by which competition can be effectively managed."

Does the bill create too much complexity? The bill abolishes primary care trusts, half the national arm's length bodies and the strategic health authorities. Monitor will be expanded to be a "provider regulator", Howe says.

He turns to Owen and Rea's amendments.

He says the idea that this bill does not appear in the Tory and Lib Dem manifestos and the coalition agreement is "untrue". He runs through the government's consultation on the bill, and says post-legislative scrutiny will be brought forward from five years to three years. "To vote for Lord Rea would be directly counter to the role and functions of this house," Howe says. (Rea's amendment would deny the bill a second reading.)

"I don't feel that a further select committee would add significant value to our normal processes," he says, referring to Owen's amendment. The floor of the house is the best forum to analyse the bill, as this debate proves, he says.

There is no way the house can make sure the committee reports back by December without putting an end date on discussion of the bill as a whole, he says. There is a lot of dispute in the chamber about this. Lord Hunt says if the Lords wants something to happen, it happens. "I do not believe it is impossible for agreement to be reached on this," Hunt says.

Howe says that offer comes at a late stage - prompting more grumbling.

Labour's Lady Royall offers to have the whole thing wrapped up by January. Howe says he accepts that. But he still rejects Owen's amendment. It would still introduce uncertainty into the passage of this bill, he says.

Lord Rea is speaking now. (His amendment would deny the bill a second reading.) He says the bill must be "sent back to the drawing board, so that the NHS can get back to work without a Sword of Damocles hanging over it". Many doctors have told him the same thing.

The peers are now preparing to vote on Rea's amendment.

The peers are back.

Lord Rea's amendment has failed by 354 to 220.

The second reading goes through.

Lord Owen introduces his amendment.

He says it is not without precedent. The constitutional reform bill went through a similar select committee procedure.

Lord Owen says he is in favour of giving the bill a second reading, but wants to improve it.

He says he and Hennessy accept the government's point about not unduly delaying the bill by sending part of it to a select committee.

He points out that Lady Royall, the shadow leader of the house, has now promised it would all be finished by January.

Owen says the select committee route is better than discussion on the floor of the house because "there are a number of amendments that need to be made to the secretary of state's powers, and they need to be connected". This is a very complex bill, Owen says.

"I agree that there should not be delay. But a matter of a week or two is a bit rich from a government" that already "paused" the bill and had a "listening exercise", he says.

He does not want to be on the select committee, says Owen.

"It is not a delaying measure."

.

Lord Ashdown, the former Lib Dem leader, interrupts. "I find it difficult to understand why a select committee in which few of us will be a member of is better at holding this bill to account than the whole of this house," he says.

If the house cannot do that, "what on earth is our function?"

Lady Royall stands to say she is not arguing for a timetabling motion, but if Owen's amendment goes through her benches will try to ensure the bill goes through by January.

If not, "usual channels should discuss the appropriate number of days needed".

Lord Howe stands up again, arguing against Owen's "twin-track approach", which risks a "disconnect" between what is happening in the select committee and what is happening in the chamber.

He says again he will make "any necessary amendment to put it beyond doubt that the health secretary remains accountable for a comprehensive health service".

The peers are now filing out again to vote on Owen's amendment.

To recap, if Owen's amendment goes through, the part of the bill relating to competition in the NHS will be sent to a special select committee.

Howe, for the government, has said this will risk such a delay it might kill the bill.

But Owen and Labour's Lady Royall have been trying their best to allay concerns about that.

The peers are back.

Lord Owen's amendment has failed, by 262 to 330.

The bill passes to its next stage without Owen's amendment.

The Department of Health has sent a response to the Lords' votes today.

On the bill going through the vote on second reading, a Department of Health spokesperson said:

The vote today moves us one step closer to delivering a world-class health service that puts patients at its heart and hands more power to health professionals. We now look forward to working with the Lords to scrutinise the bill during committee stage to improve our plans further.

On Lord Owen's amendment, which failed, the spokesperson said:

Today's vote is an important step towards giving the NHS the clarity and certainty it needs, and delivering a world-class health service for patients. We look forward to full scrutiny in the main Lords committee, drawing on peers' wide expertise to ensure that our modernisation plans are as effective as possible.

My colleague Randeep Ramesh, the Guardian's social affairs editor, has sent me this:

When Lord Sugar tweeted to his 1.1m Twitter followers that there were "big votes in Lords today for peers to #savetheNHS" many had hoped the great and good that line the leather benches might heed his sage advice. Unfortunately for the bill's opponents, the coalition's peers, in the words of one tweeter, "ignored the democratically self-selected will of Twitter". That the bill has not been paused to examine its constitutional ramifications does not mean that peers will not have time to examine the bill; the Lords will expect the government to fill in the gaps in policy in the coming weeks before giving their assent. It is here where critics of the reforms hope significant amendments could still be made to the bill. The key areas remain the duty of the secretary of state to provide a comprehensive NHS; focusing the new regulator on the issue of integrating services rather than making them compete; and making the new GP commissioning groups more accountable and less ridden by conflicts of interests. But it does mark a shift in the politics of the debate. The Lib Dem leadership, which has already signalled amendments will be accepted, have now dipped their hands in the blood of the NHS bill. It might be a stain that is hard to rub off.

Here is a summary of today's key events:

• The House of Lords has passed the government's health and social care bill at second reading. An amendment by Lord Owen that would have sent part of the bill to be examined by a special select committee - which some thought could derail the bill fatally - failed by 262 to 330. An amendment by Lord Rea that would have stopped the bill in its tracks failed by 220 to 354.

• The bill now goes to committee stage, report stage and third reading in the Lords, before heading back to the Commons. It abolishes primary care trusts and strategic health authorities, replacing them with consortia and commissioning bodies led by GPs. It also potentially increases the use of private healthcare within the NHS.

• Lord Howe, the health minister, attempted repeatedly to reassure peers that the duty of the health secretary to remain accountable for a comprehensive NHS will not be threatened by the bill, and said he would make "any necessary amendment" to the bill to ensure this was enshrined in statute.

• A 38 Degrees online petition against the bill now has over 150,000 supporters.

My colleague Randeep Ramesh has sent me the full breakdown of the vote on Lord Owen's amendment.

Six bishops voted for the amendment, 46 crossbenchers, and 198 Labour peers, 10 others, plus two Lib Dems: Lady Nicholson and Lady Tonge. No Tories voted for the amendment, and Lady Williams, who has been a leading Lib Dem opponent of the bill, appears not to have voted.

193 Tories voted against the Owen amendment, plus 51 crossbenchers, 80 Lib Dems, and six others. No Labour peers voted against.