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Harriet Harman questions the prime minister, compared with the previous Tory claims that the reorganization is a waste of money

Harriet Harman, the acting Labour leader, today challenged David Cameron to spell out the cost of the radical reforms planned for the NHS in light of previous Conservative claims that reorganisation causes disruption, demoralisation and an "inexcusable" waste of money.

Acting Labour leader also called on Cameron to confirm that planned reorganization will cancel the warranty, which provides cancer patients visiting a specialist within two weeks of seeing their GP - First Trust before work.

In a robust exchange, Cameron refused to be drawn on the specifics, telling Harman that targets that contribute to "good clinical outcomes" will stay.

He also claimed Labour was more interested in defending NHS bureaucracy than ensuring money reaches the frontline, and seized on comments made by the shadow health secretary, Andy Burnham, who has criticised the decision to ringfence NHS spending.

The prime minister said: "We will only keep targets where they actually contribute to clinical outcomes. We all want to see a higher survival rate for cancer. After 13 years of Labour government I'm afraid we have not the best cancer outcomes in Europe. We want the best outcomes. That means rapid treatment, yes, but it also means rapid follow-up. It also means getting the radiotherapy and the chemotherapy and the drugs that you need, those are all essential."

He went on: "We will continue to put real-term increases into the NHS, whereas, as I understand it, it's now Labour policy to cut the NHS."

Harman said Cameron's failure to give a specific answer on the two-week cancer target suggested he was "ditching the guarantee", but health minister Simon Burns later told the BBC's World at One programme that it was staying in place.

However, a statement subsequently issued by the Department of Health suggested it might be removed in the future by the new NHS commissioning board in favour of a more "refined" measure.

A DoH spokesperson said: "The cancer waiting time targets are clinically justified, and have been retained. The NHS commissioning board may in the future decide that the cancer waiting time targets can be replaced with more refined measures that are even more clinically justifiable - but these will have to be in support of our overall aim of improving cancer survival rates above the European average."

Harman pressed Cameron to be "more straightforward" on the overall cost of reorganisation plans outlined in a white paper published earlier this week by the health secretary, Andrew Lansley.

\\ "Of course, he must know the figure. How many more will it cost next year?" Asked Harman.

The document, entitled Liberating the NHS, presents plans that could represent the biggest shakeup of the NHS in a generation, with a whole tier of the NHS decapitated. Under the proposals 10 strategic health authorities will be abolished by 2012 and the 150 primary care trusts scrapped by 2013. Up to 30,000 managers face losing their jobs or being redeployed.

Cameron told MPs that as a result, the Government will cut ?? 1 billion in the administration of the NHS, and 45% for the whole parliament, unlike Labour, who according to him, "to protect the vast bureaucracy."

While the opposition was defending the managers who face the axe, the government was focusing on putting the money on "treatment, patients, doctors and nurses", said Cameron.

Harman said he was not answering the question: "He's talking about longer term, speculative savings, but he has not answered my question. And it's no good him resorting to his usual ploy of asking me questions. I'm asking about the real costs of his re-organisation next year ... The white paper admits there will be extra costs because of loss of productivity, staff relocation, redundancy. Does he stand by what he said just a few months ago about NHS reorganisations?

He said: "violation awful. Demoralization worse. And a waste of money is inexcusable."

Cameron said the plan was not to reorganise the bureaucracy, but to scrap it altogether. "We are scrapping the bureaucracy. Is she really going to be left, is this Labour's great new tactic, to be left defending the bureaucracy of PCTs and SHAs and all the quangos and all the bureaucrats, all of whom are paid vast salaries and huge pensions? So is that the new divide in British politics?"

The 30-minute PMQs session also saw the PM brand parliament's expenses watchdog "overly bureaucratic and very costly", and called on its staff to "get a grip".

Cameron hit out at the Independent Parliamentary Standards Authority (Ipsa) following numerous complaints from MPs over late payments and a complicated computerised system.

David Davies, the Conservative MP for Monmouth, said: "As far as I'm aware, it's not standard practice in the public sector for workers to fund their offices and equipment out of their own pockets â€" and then to negotiate a bureaucratic obstacle course in order to get the money back if they're lucky.

\\ "Could you tell us what you think it's a good system for members of parliament, or he 's undermining efforts with members of all parties at home."

Prompting cheers from MPs, Cameron replied: "I have to say â€" and I will answer you seriously, I think it is important â€" what we wanted to have and what is necessary is a properly transparent system, a system with proper rules and limits which the public would have confidence in," he said.

"But what we don't need is an overly bureaucratic and very costly system and I think all those in Ipsa need to get a grip on what they are doing and get a grip on it very fast."

Ipsa was set up in the wake of last summer's expenses scandal and now has sole responsibility for processing, validating and paying or rejecting MPs' claims.