Will changes save the Health Bill?

GPs fear changes could make the NHS reforms worse if commissioning plans are dumbed down. Susie Sell reports.

Andrew Lansley: told MPs the Health Bill will be changed
Andrew Lansley: told MPs the Health Bill will be changed

As recently as March, the Health Bill seemed to be cruising through the House of Commons at breakneck speed.

Despite concerns expressed by health professionals, unions and the likes of the RCGP and BMA, it was waved on by MPs at each stage with calls for amendments mostly ignored.

But its trouble-free journey was interrupted when the government announced a 'listening exercise' ahead of the Bill's final reading in the Commons amid growing opposition. The pause came also as speculation mounted that the Bill in its current form would not make it through the House of Lords.

Now, following this month's local election catastrophe for the Liberal Democrats, deputy prime minister Nick Clegg is vowing to stand in its way unless key changes are made.

The Liberal Democrats look like they mean business too - the party's peers led a House of Lords revolt last week that wrecked government plans for elected police commissioners. The Health Bill could yet go the way of the Police Reform Bill.

The rapid turnaround in the Health Bill's fortunes in the space of two months must have left the health secretary wondering just what went wrong.

Speaking in parliament this month he committed to making substantive changes to the Bill.

Which parts will change?
While many welcome the commitment that the listening exercise will not be purely cosmetic, questions remain about which parts of the Bill will change, whether changes will really be significant, and for the better.

Wessex LMCs chief executive Dr Nigel Watson says: 'I am sure we will get a Bill. The concern is we are getting something worse.'

More clinical control of commissioning services for patients is one element of the reforms GPs have largely backed. But some fear GP commissioning plans will be undermined in the drive to 'improve' the Bill.

NHS Alliance chairman Dr Michael Dixon says he is concerned that GP commissioning will be watered down, because of the sudden focus on what consortia boards should look like. 'My real fear is that the government will dumb down the plans, straightjacket GPs and make consortia look painfully like practice-based commissioning and all the systems that went before,' he says.

'My plea to the Liberal Democrats, the prime minister and the health secretary is, whatever compromises they feel they need to make, don't dumb down GP commissioning.'

The concerns are shared by GPC negotiator Dr Beth McCarron-Nash, who worries that the DoH will just 'tinker around' with the structure of GP consortia, and not alter more controversial plans around increasing competition in the NHS.

Criticism of plans
Criticism of plans to hand economic regulator Monitor a duty to enforce competition has been rife since the White Paper Liberating the NHS was published. But members of the expert panel leading the listening exercise - the NHS Future Forum - suggest the government could yet rethink its plans.

Talking on the Today programme, Sir Stephen Bubb, NHS Future Forum choice and competition lead, said the panel may ask the government to water down Monitor's powers.

'We may recommend removing "promote competition" from the Bill,' he said. 'It is one of the points that a lot of people have been making to us.'

The listening exercise is set to close next month, with the government expected to respond in the following weeks.

Whatever the government decides, NHS reform now has built up a high profile. This will make it tough for the government to avoid a huge backlash from patients, the profession and the electorate if it ploughs on with its plans unchanged.

As Dr McCarron-Nash points out: 'It's not too late. Everything is still to play for.'

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