The government is tonight facing a knife-edge vote on its plans to introduce foundation hospitals.

Despite a majority of 164, ministers have been forced to return from official duties to attend the vote.

Lord Clement-Jones, Liberal Democrat health spokesperson said:"The government has made further welcome concessions today and is in full retreat.

"The government should drop its obsession with foundation trusts. Foundation trusts are still a dangerously flawed and untried concept which will massively increase the costs of bureaucracy in the NHS."

Tim Yeo MP, shadow secretary of state for health and education said: "I would like to take this opportunity to explain why the Conservative Party are opposed to the government's plan for Foundation Hospitals.

"Conservatives believe in setting the NHS free. The government's plans for Foundation Hospitals don't do this. They maintain the controls from the centre and the bureaucracy of star ratings, targets and inspection. Worse, new controls and costs are added including the costs, estimated at £67m of the new governance arrangements.

"Also, by requiring Foundation Hospitals' borrowing to be within the Department of Health's control, their borrowing could prejudice investment in other parts of the NHS.

"We want to set all hospitals free to serve patients better."

Forum Response: Institute of Directors

Geraint Day, health policy analyst at the Institute of Directors, told ePolitix.com:"The Commons vote on foundation hospitals is a crucial one. This bill will free up much of the top-down bureaucracy in the NHS and should, over time, play an important part in creating a more user-responsive NHS."

Forum Response: Mutuo

Peter Hunt, director at Mutuo told ePolitix.com: "There are five key reasons why Mutuo supports plans for NHS Foundation Hospitals it is a public service in the public interest, NHS Foundation Hospitals empower patients.The public will hold the majority of seats on the Governing Bodies, giving a real say in how Trusts are run to local communities. This will deliver real social ownership of a key public service to ordinary citizens.

"It will build workplace democracy as NHS Foundation Trusts empower staff. All staff members gain the constitutional right to be involved in the governance of NHS Foundation Trusts. This means that hospitals will no longer be dominated by consultant clinicians, with a guaranteed role for all staff, including nurses, porters, cleaners and administrative staff.

"By replacing quangos NHS Foundation Trusts are accountable. Currently, NHS Trusts are run by unaccountable quangos - this legislation gives local health stakeholders the final say over all non-executive appointments to the Trust Boards.

"They will Introduce local management thereby reflecting local needs and reduce Whitehall dominance. NHS Foundation Trusts will be free to deliver healthcare in the interests of their local communities. Trusts will reflect local health priorities by giving their managers the freedom to take decisions they are best equipped to take, in place of unaccountable civil servants in Whitehall.

"NHS Foundation Trusts are dedicated to openness therefore transparency will replace bureaucracy. The applicant trusts have made great strides in devising meaningful governance structures, which have now been open to public scrutiny since early September. Mutuo has been impressed by the sensible and coherent approach of NHS professionals to this new task, and their willingness to learn from established mutuals."

Forum Response: BUPA

Duncan Cantor BUPA's senior policy analyst told ePolitix.com: "Whilst Foundation Trusts are an important issue, the controversy surrounding them has, in BUPA's view, obscured the more important issue in the Bill: that of how healthcare is regulated. Foundation Trusts alter the structure of the NHS but will not necessarily have any direct impact on patient care, whereas how public and private healthcare is regulated will.

"The Bill will create two new regulators: the Commission for Healthcare Audit and Inspection (CHAI) and the Commission for Social Care Inspection (CSCI). Importantly, although the new CHAI will regulate both the public and private sectors, two different sets of regulations will be used.

"BUPA believes that there should be an explicit policy aim to bring all hospitals together under a common standards and inspection regime across both the NHS and independent sector (i.e. a level playing field). However, at present, there seems to be no requirement to develop this common approach within a particular timescale. In fact, it seems that CHAI is planning to keep the two sectors apart and 'regulate' them in parallel for the time being.

"Independent hospitals are caring for an increasing number of NHS patients under the Concordat, and consultants frequently work in both sectors so a common approach to inspection would be sensible. It will lead to greater simplicity for the patient and clarity for NHS Trusts and independent hospitals. However, to move towards this, there will probably need to be a change of approach for both independent and NHS hospitals. Independent sector hospitals currently work to transparent, published and sometimes bureaucratic regulations and minimum standards. NHS hospitals currently work to the much less explicit principles of clinical governance.

"For the benefit of patients, staff and the management of both NHS and independent sector hospitals, the Health and Social Care Bill should pass so that CHAI can take on the role of a single regulator using a single set of standards - created in consultation with both sectors - as quickly as possible."