Health Bill's future hangs in balance

Despite all the debate and interest in the NHS reforms, the Health Bill that will underpin them is not yet halfway through its parliamentary journey.

Dr Wollaston: hopes Health Bill can now move forward
Dr Wollaston: hopes Health Bill can now move forward

Next week, after weeks of relative quiet during the summer recess, noise around the Bill will restart as parliament goes back to work. In fact, the possibility that the Bill could be scrapped in its entirety remains real, the BMA and members of the House of Lords believe.

Mounting criticism of the Bill earlier this year forced the government to launch the NHS Future Forum listening exercise in April. Subsequent amendments to the Health Bill in June initially seemed to have appeased critical MPs and GP leaders.

But just days before parliament's summer recess in July, the BMA launched a campaign to scrap the Bill entirely.

Further amendments
GPC deputy chairman Dr Richard Vautrey says the call to scrap the Bill was made because so many further amendments are needed.

'Rather than patching the Bill up we need to start afresh and look at the needs of the NHS and how best to achieve those,' he says.

But the BMA could be fighting its corner alone, as others believe the time has come to push ahead with the reforms.

National clinical commissioning network lead at the DoH Dr James Kingsland says a 'tipping point' has now been reached with the Health Bill. What's needed now is to 'just get on with it', he says.

'If we have another major exercise and review and talk about new structures we may well lose momentum,' he says.

'We need to get the Bill through and get on with it. Sometimes the NHS does a massive amount of strategy and not a lot of implementation.'

Conservative MP and former GP Dr Sarah Wollaston (Totnes, Devon) warns that scrapping the Bill would be 'damaging'.

She says the changes to PCTs have now reached the point where it would 'not be possible or sensible' to restore their original remit. 'Those who want to scrap the Bill rarely seem to have a constructive alternative,' she says. 'I hope we can now move forward.'

NHS Alliance chairman Dr Michael Dixon agrees that the Bill now needs to progress quickly through parliament.

'Further delays will just allow the same people to restructure the environment so when clinical commissioning groups (CCGs) get their feet under the desk they are already having to dance to the tune of a system that's bedded down,' he says. 'It would be much better to get CCGs moving fast.'

The NHS Alliance and National Association of Primary Care (NAPC) both believe that concerns can be addressed through a clear narrative and clarification of how the new system will work.

As prominent NAPC member Dr Charles Alessi, a GP in Surrey, says: 'We are at a stage where we cannot further delay... there is really important work to be done in terms of commissioning and provision.'

But the hope for the Bill to go ahead in its current amended form may well be thwarted as it moves to the Lords, which is expected to happen later this month or next month.

Dr Vautrey believes that the Lords will provide a key opportunity to get the Health Bill scrapped. 'The Commons was inevitably going to vote along whip lines,' he says. 'I think we will see much more serious debate in the Lords. There are many informed and independently minded peers who will be listening to the concerns the BMA has had about the Bill and will be wanting to raise those on the floor of the Lords.'

Some Lords are already bristling for a fight. Labour peer Baroness Thornton believes there will be a lot of interest in the Bill.

'Across the cross-benchers, the Liberal Democrats and Conservatives, there are a lot of questions about how this Bill will work,' she says. Baroness Thornton adds that some Lords are 'very unhappy' with the Bill and may vote against it or table amendments.

Many Lords have already expressed concerns about the Bill. Former Labour health secretary Lord Owen has warned that the Bill is 'flawed' and will mark 'the end of the NHS as conceived in 1948'.

NHS reforms: Interactive Health Bill timeline

Click on the image below to track the progress of the reforms through our daily coverage of key events

NHS Reforms timeline

'Betrayal of trust'
Liberal Democrat Baroness Tonge is set to vote against the Health Bill entirely. She believes it is an 'outrageous betrayal of trust' and will break up the 'crucial' doctor-patient relationship.

'I totally agree with the BMA,' she says. 'I am opposed completely to the Bill and think it should be thrown out.'

Baroness Tonge says the Lords' views about the Health Bill are mixed, with some 'furious' and others supporting parts of the Bill, such as the scrapping of PCTs.

She says the House of Lords could throw out the Bill altogether, but even if this does not happen there are likely to be a number of 'complicated amendments' introduced.

The amended Bill would then go back to the Commons, she says, where the government would be faced with two options: delay the Bill further, as the amendments are thrashed out, or back down.

The government may have thought that the listening exercise would be enough to soothe disquiet over the Health Bill. It now looks certain that is not the case.

Just as the Health Bill has a huge journey ahead, so does the government in convincing GPs and the Lords that its reforms are the best remedy for the NHS.

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