A vote on changes is due on Wednesday

Health Secretary Alan Milburn says he will quit his post if patients end up having to pay for treatment in his proposed foundation hospitals.

The pledge came as he and Tony Blair sought to win backing for the measures in the face of widespread opposition among Labour MPs.

Their efforts to avoid what would be a humiliating House of Commons defeat on the issue on Wednesday might be made harder by indications the Tories may vote against the plans.

Former Labour health secretary Frank Dobson said Mr Blair had no mandate from voters or the Labour Party to introduce foundation hospitals, warning that the result is likely to be charges for patients.

I will resign if there was a question of introducing more charges for NHS patients - that is not what this is about Alan Milburn Health Secretary

More than 130 Labour backbench MPs have signed a motion opposing the creation of foundation hospitals - elite hospitals freed from Whitehall control with fundraising powers.

The Liberal Democrats have already declared their opposition.

If the Tories, Lib Dems, Scottish and Welsh Nationalists all vote against the bill, that would be about 225 votes. That would mean just over 100 Labour MPs would have to rebel for the plans to be defeated.

This outcome is still seen as unlikely by Mr Milburn and privately some opponents concede that the size of a Labour rebellion likely to fall if the Tories voted against.

Quit pledge

The Labour MPs opposed to the plan, and union leaders, fear the new hospitals will create a "two-tier" health system by taking the lion's share of NHS money, leaving ordinary trusts behind.

Mr Milburn told the Daily Mirror he knew the policy was controversial, but insisted that it was necessary to reform the health service.

The logic of the position about competition in the NHS, and moving away from being a provider, is charges, vouchers Frank Dobson Ex-Labour health secretary Reform is 'Labour's poll tax'

He added: "I will resign if there was a question of introducing more charges for NHS patients - that is not what this is about.

"Charging people for their treatment and care will never happen while I'm Secretary of State."

Mr Milburn said he was not interested in a two-tier health system, but in improving the quality of all hospitals.

"You can't run the National Health Service as if it's the Chinese Red Army from an office in Whitehall," he said.

Patchy and messy

The prime minister, in an article in Sunday's Observer newspaper, said all hospitals would be able to apply for foundation status at some time, claiming therefore the "two-tier" argument was redundant.

The article said: "I believe that when these foundation hospitals are up and running, people will look back and wonder what the controversy was about.

Will reforms improve NHS?

"One of the strangest aspects of this argument is that the government is being attacked for putting frontline health staff and local communities in the driving seat in the NHS.

"When the criticism comes from many who for the past six years have accused this Labour Government of control freakery or worse, then it is stranger still."

Conservative leader Iain Duncan Smith's most outspoken attack yet on the idea of foundation hospitals held out the prospect that his MPs might be asked to vote against the plan on Wednesday.

Mr Duncan Smith told BBC One's Politics Show that the prime minister "cannot and should not" rely on Tory support for "patchy" and "messy" legislation.

Ministers were telephoning backbenchers over the weekend in an attempt to get them on-side.

Party divisions

Labour Party chairman Ian McCartney told BBC Radio 4's Today programme that reform of the NHS had been backed by the Labour Party at its 2002 conference.

But Mr Dobson told the Independent on Monday: "This proposition was being discussed privately before the general election, was never put to the electorate so we have no mandate for it from the public and has never been agreed by any policy making body in the Labour Party.

"The logic of the position about competition in the NHS, and moving away from being a provider, is charges, vouchers."

Liz Kendall from the Institute of Public Policy Research, a traditionally Blairite think tank, said the proposals were bound to cause division.

She told the BBC: "The question is, if you want to move away from a situation where the government is trying to control everything from within Whitehall - which I think most people agree is a good idea - that will inevitably mean more differences emerging.

"You can't have it both ways. I think the government's priorities should be more about focusing on local, primary care services rather than hospital services."