Out-of-hours care provider Harmoni says it may need 'a more attractive employment package', after CQC review

A privatised out-of-hours GP service in north and central London does not have enough qualified, skilled or experienced staff to ensure it can meet patients' health needs, a watchdog has found.

The verdict on Harmoni's operations in part of the capital comes months after a coroner ruled that no individual or systemic failing by the company was to blame for the death of a seven-week-old boy.

The Care Quality Commission found the shortcomings during an inspection of care and treatment records in March, following a Guardian investigation into understaffing of the service. It found that Harmoni fell short on targets for triaging both urgent and non-urgent calls, and for making urgent home visits within two hours and routine ones within six hours.

The CQC found that 52 shifts had been cancelled at short notice between October last year and the end of December, with one doctor cancelling on seven occasions.

Harmoni, the largest private provider of out-of-hours GP care in England, has contracts with 110 GPs and uses agency staff to provide services in north and central London.

Harmoni told the CQC that difficulties in recruiting enough GPs played a part in the failure to meet the required standards, as did underestimates of cover needed for the bank holiday period. It said it may need "a more attractive employment package".

The CQC said 22% of patients who responded to a survey in December said the service was poor or unsatisfactory, and in a survey in January the figure was 17%. Until the staffing issue was resolved, "there is a risk that delays could affect the care and treatment by patients using the service", its report said.

Lawyers for the parents of Axel Peanberg King, who died last November after a cold developed into pneumonia, believe the criticism supports their contention that the service was not staffed properly and therefore could not provide the care it should have done.

In February, Shirley Radcliffe, the coroner who investigated Axel's death, delivered a narrative verdict, which did not apportion blame. She concluded that Harmoni's overall systems were safe and rigorous, although she concluded that the performance of the last doctor who had been in contact with the family had been inadequate.

That doctor had taken one minute to investigate Axel's condition in a phone call and made "wholly inadequate" notes of the consultation in between seeing patients, booked at a rate of five an hour, at a Harmoni clinic where he was on duty, the inquest heard. By downgrading Axel's case from urgent to routine, there was a delay in him seeing a doctor the day he died.

Ellen Parry, the lawyer at Leigh Day representing Axel's parents, said: "This report supports our belief that the out-of-hours service run by Harmoni was not staffed properly and therefore did not provide the service it should have to our client and her baby boy, Axel.

"Harmoni must realise that the safety of the service is directly linked to both adequate and appropriate recruitment and the service cannot be considered safe until they have solved this issue. If they cannot ensure adequate staffing, by good doctors, then I believe that the service is not fit for purpose and should be taken out of private, profit-based ownership."

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Oliver James's assertions are unhelpful and risk demonising people

In more than 30 years of clinical practice, mostly in general practice, I have encountered much mental illness and experienced it in family members also. To polarise the debate between organic psychiatry looking for elusive biomarkers and promoting drug-based treatments versus Oliver James's assertion that "abuse is the major cause of psychosis" is unhelpful ("Medicine's big new battleground: does mental illness really exist?", News).

Primary-care physicians, who see and treat the vast majority of mental illness in the UK, are trained to see presentations of illness in biological, psychological and social terms. All are relevant. To classify abnormal behaviours as distinctly separable "disorders" or "diagnoses", as the Diagnostic and Statistical Manual seems to be trying to do, is as unhelpful as, say, classifying diabetes as an eating disorder.

In The Spirit Level: Why More Equal Societies Almost Always Do Better, Wilkinson and Pickett demonstrate quite clearly that health and social problems, particularly the prevalence of mental illness and drug and alcohol use, are highest in those countries with the greatest income inequality. The UK rates very badly in this respect. This realisation, and action to tackle it, is the "paradigm shift" that is needed, not a sterile debate about nomenclature.

Dr Ed Morris

Witney

Oliver James claims that "it is becoming apparent that abuse is the major cause of psychoses". Unless accompanied by strong evidence, that statement is highly irresponsible, given that it points suspicion at the families of people suffering from an often devastating disorder. Such families, often already mistakenly burdened with shame, do not need yet another witch hunt. There is some evidence that rates of exposure to abuse are elevated in people who develop some forms of psychosis, but that is far from evidence that abuse is "the major cause".

Although he is unknown in the scientific community as a researcher into the origins of psychosis, James must know very well that correlation does not equal causation and that the sort of study he mentions cannot make it "apparent" that abuse makes any causal contribution. That he then attributes a causal link between abuse and psychosis to an unspecified and, as far as I know, non-existent mechanism he calls our "electro-chemical thermostats" does not change that.

Michael O'Donovan

Professor of psychiatric genetics/honorary consultant psychiatrist

Cardiff University

The argument about whether mental illness exists or is a construct of the psychiatric profession is a retrograde step. It is not helpful to the thousands of people who contact Sane and who struggle with mental ill-health, or to those who are responsible for their care. Nor does it advance research into understanding underlying causes.

We do not ask similar questions about the existence of cancer, heart disease or diabetes. There, the focus is on the search for more effective treatments and cures.

Marjorie Wallace

Chief executive, Sane

London E1

No one has identified the real villains of the piece. In the US, the insurance giants rule the mental health world and it is they that require a diagnostic map to enable them to determine who gets treated for what, by whom and for how long. The clinician assesses the client and informs the insurer, which pays him/her, including a DSM diagnosis. The insurer then ticks boxes and replies something like "six sessions of cognitive-behavioural therapy". I found that approach appalling.

In this country, psychiatrists leading large multidisciplinary teams make these decisions and are hardly likely to relinquish the power and enormous salaries they enjoy should any model other than the medical be used. I find that approach pretty dreadful too.

Dr Mary Wrightson

Oundle

Northamptonshire

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Concerns that firms' rights to hold patents on genes linked to breast cancer is pushing up cost of testing for disease

Angelina Jolie's decision to speak out about her decision to have a preventive double mastectomy was intended to highlight the terrible risks of breast cancer. But the film star's move also cast a spotlight on the far less known arena of patent battles over genetic technology which could have far more impact than Jolie's widely applauded move.

Before the end of next month the US supreme court will issue a landmark decision in a case brought against the biotech firm Myriad Genetics, which is based in Utah, by the Association for Molecular Pathology.

The firm owns a patent on the BRCA1 gene, which Jolie carries and which is believed to carry a high risk of causing breast cancer. It also owns a patent on the similar BRCA2 gene.

It means that Myriad has the exclusive right to develop diagnostic tests for those genes – a fact that has implications for other firms, who thus might be prevented from developing innovations in the field.

It also has some serious hard-money business implications: in the wake of Jolie's announcement, Myriad's share price shot up. That has worried some commentators. In a New York Times column describing her decision, Jolie acknowledged she was lucky to be well-off enough to easily afford to take the test for the culpable genes.

Some have complained that the lengthy court battle over Myriad's patents has kept the price of the tests too high and have asked whether patents actually sacrifice patients' interests in favour of protecting corporate profits. "How many more women – and men – might have been able over the past four years to afford BRCA1 or BRCA2 testing in the absence of those protective patents?" wrote Andrew Cohen in Atlantic magazine.

The issue of patents and genetic technology is one of growing importance as a flood of companies enter the booming sector and scientific advances allow more and more advanced genetic manipulation. So far the supreme court has shown a willingness to side with big business. Earlier this month it ruled in favour of agricultural firm Monsanto in defence of a patent it holds on soy beans that dominate the US farming sector.

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NHS Direct staff 1,200 smaller in number than in 2009-10, resulting in 120,000 more hospital referrals in the past year

The NHS Direct health advice service referred an extra 120,000 patients to accident and emergency departments in the past year, compared with the final 12 months of the Labour government.

The increase in the number of calls to the 0845 service that were considered to require "urgent or emergency" assistance came as staffing levels dropped significantly. More than 1,200 fewer people worked on NHS Direct in 2012-13 compared with 2009-10, according to figures from the service. The numbers appear to offer an explanation for at least some of the huge increase in people attending A&E departments and a crash in performance there in the last year.

Of the 143 trusts that have large A&E units, only 18 have hit the target of treating 95% of patients within four hours, with the goal being missed by a widening margin in recent months.

Jeremy Hunt, the health secretary, has claimed that this is due to an extra 4 million people a year attending A&E compared with the numbers under the last government. He has blamed doctors' contracts in 2004 allowing GPs to opt out of offering out-of-hours services for pushing people into hospitals. However, the figures suggest that other factors are at work. The coalition has been running down the NHS Direct service, about 40% of whose staff were nurses, since announcing in summer 2010 that it was to be replaced by a 111 helpline run by private call centres.

However the 111 service, introduced nationally on 1 April, has been beset by major serious problems, with many patients unable to get through for hours or being given poor advice and arriving at A&Es in frustration. The figures revealed today show that, as the NHS Direct service has been winding down, it has been pushing more people to hospitals. The proportion of calls referred to A&E in 2009 was 24% of the 4,864,035 calls, up to 36.5% of 3,585,954 calls in 2012. Suresh Chauhan, of the campaign group 38 Degrees, who obtained the figures, said he feared the 111 helpline, run by staff who lack medical training, was sending more people to A&E than NHS Direct, compounding the problem. "The real cause of this crisis is a policy decision made by this government when it came to power in 2010," he said. "They decided to dismantle the NHS Direct service which triaged out-of-hours calls for medical aid.

"This service, called the 0845 line, had been working for a few years then and had an impressive record of processing the calls by listening to actual problems and giving appropriate guidance." Alan Milburn, who negotiated the GPs' contract changes in 2004, said it was "complete nonsense" to claim that reforms introduced nearly a decade ago to improve GP recruitment were hitting performance levels in emergency wards today. Milburn, an adviser to the coalition on social mobility, said ministers needed to explain why performances in A&E departments had improved in the latter part of the Labour administration, only to worsen since 2010.

"It's complete nonsense and totally spurious to claim a deterioration in accident and emergency performance which only took effect in the last 18 months can somehow be tracked back to a GP contract change from 2005," he said. "Jeremy Hunt is blaming the wrong government. He has to explain how the NHS managed to improve accident and emergency performances despite an increase in the numbers of people attending up until 2010, but has since failed to do so."

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Maggie Boyle to leave post months after operations at LGI children's heart unit were suspended over high death rates

An NHS trust at the centre of a row over death rates for children's heart surgery is to replace its chief executive.

Maggie Boyle will leave Leeds Teaching Hospitals NHS Trust (LTHT) next month, ahead of a management shakeup which follows fears over high mortality figures.

Operations were temporarily suspended earlier this year after concerns were raised over death rates at the children's heart unit at Leeds General Infirmary (LGI).

Boyle is not believed to have tendered her resignation.

A trust spokesman would not confirm whether her departure was related to the heart surgery fears.

Boyle, a former nurse, issued a statement through the trust in which she expressed support for managerial change and the implementation of a "clinically led" structure.

"It has been a pleasure and a privilege to be chief executive at LTHT over the past six years," she said. "I believe the move to new management arrangements which will see a clinically led, managerially supported structure being established is absolutely the right thing to do and will have enormous benefits for patient focused care delivery.

"I would like to wish the senior leaders and all of their staff all best wishes for a successful future."

The trust found itself at the centre of a public outcry when Sir Roger Boyle, the government's former heart tsar, raised fears about high mortality rates at LGI.

He presented data to NHS medical director Sir Bruce Keogh, who suspended surgery at the hospital's child cardiac unit for eight days while an investigation took place.

The decision - which meant 10 children had to be transferred to centres up to 120 miles away for treatment - was widely condemned. Experts claimed the information that led to the unit's closure was incomplete.

But health secretary Jeremy Hunt said suspending surgery was "absolutely the right thing" to do.

Boyle resigned from his role last month.

A trust spokesman said: "Arrangements to cover the chief executive post until a substantive appointment is made will be advised shortly."

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Retail bonds can be a minefield for investors in search of a better rate but ignorant of risks involved, say advisers

Nuffield Health, which bills itself as the UK's "leading not-for-profit provider of health and wellbeing services", this week launched a bond paying 6% a year on deposits of as little as £1,000.

The rate is more than double the interest paid on the current best-buy savings accounts, and is the latest in a string of issues from companies and organisations tapping into the public's thirst for better returns than those on offer at traditional banks and building societies.

Should savers pile in? Financial advisers polled by Guardian Money are not entirely convinced, with some arguing that savers are largely ignorant of the risks involved in retail bonds, while others say the word "bond" is itself misleading.

The Nuffield bond's interest is fixed at 6% a year for five years, payable annually, on investments from £1,000 to £250,000. Nuffield is hoping to raise £15m, with a closing date of 18 June. It is offered on a first-come, first-served basis, so any subscriptions sent in once the £15m has been reached will be returned, even if they are arrive before 18 June. The money will be used to invest in Nuffield's hospitals, clinics and gyms (it bought the Cannons chain).

The bond can't, however, be wrapped into a tax-free individual savings account. Instead, savers will have basic rate tax of 20% deducted from the interest payout at source. In other words, savers will receive 4.8% interest. If they are non-taxpayers, they can reclaim the tax, or if they are higher rate taxpayers they will have to declare the income and pay the balance – ie the rate will in effect be 3.6%.

But financial advisers caution against making direct comparisons with fixed-rate bond savings accounts. A retail bond such as the Nuffield Health Bond, and others before it, such as those from Tesco Bank, are in effect a loan to the business. If the business goes under, you lose most or all of your money – without any recourse to compensation schemes.

The Nuffield Health Bond is not protected by the Financial Services Compensation Scheme, which provides cover of up to £85,000 on conventional deposit accounts. But the lack of FSCS protection hasn't stopped savers pouring millions of pounds in recent years into retail bonds. The London Stock Exchange's retail bond platform, Orb, began three years ago and has made it much simpler and easier for the general public to buy and sell bonds in companies.

Tesco's bond issues (from its banking subsidiary, not the supermarket) have been hugely popular. Last year it issued an eight-year bond paying 5% where the underlying price has already gone up from 100p to 109p (although that means anyone buying it in the "secondary" market will in effect receive a lower yield). Hargreaves Lansdown runs a dealing service for small investors, and has in the past promoted bonds paying 6% from Provident Financial and 6.125% from International Personal Finance. But it is keen to point out that neither the income nor capital is guaranteed, and that they can fall in value.

Brian Dennehy of adviser Dennehy Weller & Co is more scathing. "A lot of these bonds appear opportunistic to us. They are not a safe, high-yield option. You are taking a lot of risk with a bond; often you are buying into a business you don't know, and where you have no idea where you stand if it goes bust. There's no safety net, and when one of these bonds goes bust, it will reflect badly on the entire financial services industry."

Evidence of just how risky bonds can be came last week from Co-operative Bank, whose bonds plummeted after a severe downgrade from rating agency Moody's. The price of one Co-op bond fell from around 150p to 90p, leaving holders with losses of around 40% of their capital.

The Nuffield Health bond worries advisers more than some other bonds, such as the one from Tesco Bank, because it will not be traded on the London Stock Exchange. Investors will have to lock up their money for five years and rely upon Nuffield still being there to return the deposit. Early redemptions are not allowed.

Kevin Doran, senior fund manager at private bank Brown Shipley, says: "The Nuffield issue underlines the importance of investors understanding what they are buying because there are important differences between this and some of the recent retail bond launches.

"The Nuffield Health bond won't be listed on the London Stock Exchange, where retail investors can trade bonds in a similar way to equities, and that means there will be no secondary market and no pricing once the issue goes live.

"Investors have to ask themselves whether they think a yield of 6% from a not-for-profit organisation running hospitals and health clubs is sufficient. They should also consider whether they want to tie their money up for five years at that yield."

He describes Nuffield's balance sheet as "not the best in the world", and says that although it had a turnover last year of £645m and fixed assets of £523m, it only managed to achieve a pre-tax profit of £4m. However, Nuffield says its turnover was up 12% on the year before, and return on capital employed rose to 15.7%.

But for advisers who aren't keen on the Nuffield bond, what are the alternatives? The yield (interest rate) on many of the bonds of utility companies and multinationals traded on the LSE have fallen steeply in recent years and many are offering only 4% or less.

At Brown Shipley, Doran rates less well-known companies such as Workspace, Unite and Enquest, which yield around 5%, but are backed by real assets such as property, or, in Enquest's case, oil flows.

Investors should also be careful to understand how tradeable bonds work. If you buy at the outset, the bond will pay the fixed amount of interest (usually known as the "coupon") and repay the capital at maturity. They are normally launched at 100p a unit, but along the way, as they are traded, their price may rise or fall. If you buy at a price of more than 100p and hold to maturity, then you are, in effect, guaranteeing that you will be losing some of your capital, although you may be happy with that if you also receive a high coupon.

When investing, it is always worth comparing the "running yield", which is a snapshot of the current price of the bond compared with the interest paid, and the "gross redemption yield", which shows you how much you'll earn if you hold it to maturity.

For more information on the Nuffield bond, go to nuffieldhealthbond.com or call 0871 664 9236.

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The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM-5, has divided medical opinion

The field of mental health will face its greatest upset in years on Saturday with the publication of the long-awaited and deeply-controversial US manual for diagnosing mental disorders.

Early drafts of the book, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM-5, have divided medical opinion so firmly that authors of previous editions are among the most prominent critics.

Known informally as the psychiatrists' bible, the $199 tome from the American Psychiatric Association is the guidebook that US doctors will use to diagnose mental disorders. The latest edition is the first major update in 20 years.

Though not used in the UK, where doctors turn to the World Health Organisation's International Statistical Classification of Diseases (ICD), the US manual has global influence. It defines groups of patients, and introduces new names for disorders. Those names can spread, and become the norm elsewhere. More importantly, the categories redefine the populations that are targeted by drugs companies.

Criticisms have come from almost every corner. There are claims of expansionism, with common experiences and behaviours becoming newly medicalised. Temper tantrums become disruptive mood dysregulation disorder (DMDD); grief becomes major depressive disorder (MDD), according to Allen Frances, an American psychiatrist who chaired the task force behind the fourth edition of the manual. Other behaviours get their own labels: overeating becomes binge eating disorder; keeping too much junk, a hoarding disorder; a bit forgetful could be mild neurocognitive disorder.

David Clark, professor of experimental psychology at Oxford University, said mental health disorders are often hard to divide into clear categories, because too little is known about them, and there can be major overlaps. But the definitions are often valuable. For example, greater distinctions between various types of anxiety have led to more specific and effective treatments, he said.

Nick Craddock, professor of psychiatry at Cardiff University, and director of the National Centre for Mental Health in Wales, said some of the stranger aspects of the US manual will have no impact in Britain. But he said DSM-5 was flawed because definitions of disorders were sometimes changed on the basis of too little fresh scientific evidence.

"I don't believe the science has advanced sufficiently in 20 years since DSM-4 to warrant making a new system," he said. "That essentially is just a group of people agreeing on tweaking things and making them a little bit different. That to me is not a very helpful stage in the develop of psychiatric diagnosis. This is the wrong time in history to change the diagnostic system. "

Changing the definitions of disorders alters who has them. That affects who gets drugs and other support, and who interventions are trialled on. If the criteria for attention deficit hyperactivity disorder (ADHD) are broadened, then more people are likely to be diagnosed with the condition.

The arrival of DSM-5 will mark the end of Asperger's syndrome in the US.

Along with some other autism-related conditions, Asperger's will now be consumed by the new category of "autism spectrum disorder".

Some people diagnosed with Asperger's are unhappy about the coming change. Carol Povey, director of the National Autistic Society's Centre for Autism, said: "The term Asperger Syndrome is a core part of their identity for many people and they understandably feel anxious about moves to remove the term. The changes won't prevent people from continuing to use it to define themselves and nor should it," she said.

Debbie Tucker, chair of the Asperger's Syndrome Foundation, said the label can be useful in treating people, but that some did not want to be labelled. "Labels only become unhelpful and sometimes dangerous if used to discriminate. People with Aspergers are vulnerable to this," she said.

Last month, Thomas Insel, director of the National Institute of Mental Health, declared that the organisation would not use DSM-5 definitions to set its research priorities. Writing about DSM-5 on his blog, he said: "The weakness is its lack of validity. Unlike our definitions of ischaemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure." Instead, he said the NIHM would lay the foundations for a new classification system, based on brain imaging, genetics, cognitive science and other research.

"We need to begin collecting the genetic, imaging, physiologic, and cognitive data to see how all the data – not just the symptoms – cluster and how these clusters relate to treatment response," he said.

Bupa approved to access sensitive medical records as campaigners question patient consent for release

Private health firms, including Bupa, can pay £140 to identify potentially millions of patients and then access their health records, detailing intimate medical histories, under a new national arrangement in the NHS, the Guardian can reveal.

The records, which include sensitive information about hospital visits, such as a mother's history of still births, patients' psychiatric treatment and critical care stays, allow individuals to be identified by use of postcode, gender and age as well as their socioeconomic status.

On Monday the government slipped out the news that private insurer Bupa was approved to access England's "sensitive or identifiable" patient data, housed centrally by the Health and Social Care Information Centre (HSCIC). It is now among four private firms that have passed the government's vetting procedures.

The charging structure for "bespoke patient-level extracts" was revealed when HSCIC put up a "cost calculator" to work out how much prospective customers would pay for sensitive hospital data. The "indicative fee" for a full set of 20 years' inpatient data was about £8,000 including £140 to make the records identifiable.

The prime minister has argued that companies such as Britain's key life sciences firms should be able to benefit from the NHS's vast collection of patient data. But critics argue that this amounts to putting the NHS "up for sale".

Campaigners say the health service is aping commercial practice – pointing out that only last week the country's largest mobile phone operator announced it was selling the internet habits of its 27m customers.

Phil Booth, coordinator at patient pressure group medConfidential, said: "People are rightly concerned when details of their mobile use or online habits are sold on; now we learn that the NHS is selling masses of highly sensitive medical information to private companies. Like millions of other patients, I'm certain I never gave my consent for that."

The Guardian has established that private companies are already attempting to access patient records which can identify individuals.

In July a private research firm Civil Eyes was granted access to sensitive "consultant code" data. However, in the same month Dr Foster, which produces a guide to good hospitals, was refused permission to obtain patient mental-health data which included date of birth, gender, marital status and NHS number.

Labour called for the practice to be "suspended immediately pending a full investigation". Shadow health secretary Andy Burnham said: "Patients will be appalled to learn that the government appears to be auctioning off their personal information to the highest bidder.

"We warned David Cameron 18 months ago that greater safeguards were needed on the use of data in the NHS. He failed to provide them and, in his drive to commercialise the NHS, he has allowed this unacceptable situation to arise. Ministers need to tell us whether they knew about this practice and whether it was given their approval".

The HSCIC said that it "only provides identifiable data when there is a lawful basis to do so, eg, with patient consent. The data we provide is normally anonymised. We do charge a fee to cover administrative costs of operating an extract/data linkage request. We are committed to ensuring information about our services are presented in a transparent and accessible way and will continue to develop our website to ensure further clarity in this area."

Dr Katrina Herren, medical director of Bupa Health Funding UK, said: "Bupa uses NHS clinical data to support the NHS with services like population health management, and also for benchmarking purposes.

"The government publishes very clear rules on how we can use the data, and we adhere to the highest standards of information governance when handling confidential information."

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Norman Lamb will argue the case to stick to policy but Tory MPs say David Cameron has been persuaded to drop it

A health minister has urged the coalition to press ahead with forcing cigarettes to be sold in plain packets to reduce sales, despite the plan being dropped from the Queen's speech because of unease in Downing Street.

Norman Lamb, a Liberal Democrat, has urged ministers to make Britain the first country in Europe to adopt what he claims would become a key element of the legacy of government's time in power.

"As a liberal I would always defend someone's right to smoke, if that's what they choose to do. But, given we're dealing here with a product that kills between 80,000 and 100,000 people a year, I think it's legitimate for government to seek to control the marketing of that deadly product," Lamb told the Guardian.

"I think it would be a legacy for this government to have legislated on something which would be a landmark public health reform and to be out there in front in Europe. It's something that both Liberal Democrats and Conservatives could be very proud of"," he added.

The care and support minister said he intended to keep fighting to secure the introduction of plain packs, even though it did not appear as expected in the government's legislative programme unveiled last week. David Cameron ditched it amid fears of a backbench revolt against a "nanny state" idea and tobacco industry warnings of job losses if it went ahead.

"MPs from all three parties support this, so I will continue to argue the case for us to act. There could still be an opportunity in this parliament to act and I will argue the case for it," said Lamb.

Other Lib Dem ministers and MPs agreed with him, he said, although the education minister, David Laws, and the Home Office minister, Jeremy Browne, who are on the right of the party, are thought to be against it. Representatives for Nick Clegg and the business secretary, Vince Cable, declined to say if either personally supported plain packs, which the Liberal Democrats have backed as a party since 2008.

MPs who support plain packs claim Lynton Crosby, the Australian brought in by Cameron to spearhead the Tories' 2015 general election campaign, helped stop the plan as part of his drive to "get the barnacles off the boat" – unnecessary policy commitments – of Conservative policy before then. Officially the policy is still under discussion, but privately supporters fear Cameron has been persuaded to abandon it.

Lamb's intervention has reignited coalition tensions over the issue. Westminster sources say the government's entire team of five ministers at the Department of Health, including the health secretary, Jeremy Hunt, support plain packs, which would end the use of glitzy packaging and manufacturers' logos and compel cigarettes to be sold in plain dark green packets featuring prominent health warnings. Australia became the first country to introduce standardised packaging last December, and New Zealand plans to follow suit.

Stephen Williams, the Lib Dem MP who chairs parliament's all-party group on smoking and health, said: "The vast majority of Lib Dem MPs would like to see this happen, including many ministers. Lib Dem MPs don't want this to drop. I've told Nick Clegg about the strength of feeling on our benches about this."

Doctors' groups and health charities back the move and say it would help reduce the 200,000 young people a year in the UK who take up smoking and also encourage adult smokers to quit. They welcomed Lamb's remarks.

"We applaud the health minister's comments. Tobacco is a uniquely dangerous product that will kill half of all long-term smokers, and existing packaging makes smoking more attractive to young people. Norman Lamb's intervention is further evidence of the strong support for plain, standardised packs in the government and across the political spectrum," said Sarah Woolnough, Cancer Research UK's executive director of policy and information.

Deborah Arnott, chief executive of the anti-smoking group Ash, said: "We're delighted that Norman Lamb has joined other ministers and politicians from all parties in parliament in backing standardised packaging of cigarettes. His decision to speak out will only add to the pressure on the government to allow parliament an early chance to vote on the issue."

She added that the coalition would not be able to reduce the number of premature deaths by 30,000 a year by 2020 unless it cut the number of people smoking.

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Norman Lamb will argue the case to stick to policy but Tory MPs say David Cameron has been persuaded to drop it

A health minister has urged the coalition to press ahead with forcing cigarettes to be sold in plain packets to reduce sales, despite the plan being dropped from the Queen's speech because of unease in Downing Street.

Norman Lamb, a Liberal Democrat, has urged ministers to make Britain the first country in Europe to adopt what he claims would become a key element of the legacy of government's time in power.

"As a liberal I would always defend someone's right to smoke, if that's what they choose to do. But, given we're dealing here with a product that kills between 80,000 and 100,000 people a year, I think it's legitimate for government to seek to control the marketing of that deadly product," Lamb told the Guardian.

"I think it would be a legacy for this government to have legislated on something which would be a landmark public health reform and to be out there in front in Europe. It's something that both Liberal Democrats and Conservatives could be very proud of"," he added.

The care and support minister said he intended to keep fighting to secure the introduction of plain packs, even though it did not appear as expected in the government's legislative programme unveiled last week. David Cameron ditched it amid fears of a backbench revolt against a "nanny state" idea and tobacco industry warnings of job losses if it went ahead.

"MPs from all three parties support this, so I will continue to argue the case for us to act. There could still be an opportunity in this parliament to act and I will argue the case for it," said Lamb.

Other Lib Dem ministers and MPs agreed with him, he said, although the education minister, David Laws, and the Home Office minister, Jeremy Browne, who are on the right of the party, are thought to be against it. Representatives for Nick Clegg and the business secretary, Vince Cable, declined to say if either personally supported plain packs, which the Liberal Democrats have backed as a party since 2008.

MPs who support plain packs claim Lynton Crosby, the Australian brought in by Cameron to spearhead the Tories' 2015 general election campaign, helped stop the plan as part of his drive to "get the barnacles off the boat" – unnecessary policy commitments – of Conservative policy before then. Officially the policy is still under discussion, but privately supporters fear Cameron has been persuaded to abandon it.

Lamb's intervention has reignited coalition tensions over the issue. Westminster sources say the government's entire team of five ministers at the Department of Health, including the health secretary, Jeremy Hunt, support plain packs, which would end the use of glitzy packaging and manufacturers' logos and compel cigarettes to be sold in plain dark green packets featuring prominent health warnings. Australia became the first country to introduce standardised packaging last December, and New Zealand plans to follow suit.

Stephen Williams, the Lib Dem MP who chairs parliament's all-party group on smoking and health, said: "The vast majority of Lib Dem MPs would like to see this happen, including many ministers. Lib Dem MPs don't want this to drop. I've told Nick Clegg about the strength of feeling on our benches about this."

Doctors' groups and health charities back the move and say it would help reduce the 200,000 young people a year in the UK who take up smoking and also encourage adult smokers to quit. They welcomed Lamb's remarks.

"We applaud the health minister's comments. Tobacco is a uniquely dangerous product that will kill half of all long-term smokers, and existing packaging makes smoking more attractive to young people. Norman Lamb's intervention is further evidence of the strong support for plain, standardised packs in the government and across the political spectrum," said Sarah Woolnough, Cancer Research UK's executive director of policy and information.

Deborah Arnott, chief executive of the anti-smoking group Ash, said: "We're delighted that Norman Lamb has joined other ministers and politicians from all parties in parliament in backing standardised packaging of cigarettes. His decision to speak out will only add to the pressure on the government to allow parliament an early chance to vote on the issue."

She added that the coalition would not be able to reduce the number of premature deaths by 30,000 a year by 2020 unless it cut the number of people smoking.

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