No part of the Health Bill is sacred

The pause in the Health Bill's progress was the right move, health select committee chairman tells Susie Sell.

Stephen Dorrell: change must be fast to meet efficiency challenge

In April, the beleaguered NHS reforms were dealt a hammer blow by a damning report from the House of Commons health select committee.

Concerns had centred on plans to drive up competition in the NHS, but the report triggered alarm about plans to cut back the health secretary's direct responsibility for providing a comprehensive health service. The report also called for a rethink on the remit of GP consortia.

Its impact was immediate. The day after the report was published, the government announced that the Bill was to be put on hold while it carried out a 'listening exercise'.

The report's significance was all the greater because the health select committee chairman, former Conservative health secretary Stephen Dorrell (Con, Charnwood) has been touted as a potential replacement for Andrew Lansley.

But speaking exclusively to GP, Mr Dorrell is quick to back the current health secretary and says the government was right to pause the Bill.

It needed to take stock of criticism of the NHS reform plans, he says. But he adds that what is needed now is clarity about how the reforms will progress.

Mr Dorrell says the key to achieving the £20 billion efficiency saving the NHS is targeting over four years is better integration of services, as well as a revamp of commissioning.

He says commissioning in the future must be a 'long way forward' from the old PCT system, which, he says, was too bureaucratic.

While Mr Dorrell believes that commissioning must be led by a majority of GPs, he says that other clinicians must be involved and consortia must include a voice for the local community as well.

This diversity of board membership is a key part of strengthened governance arrangements recommended by the health select committee. 'If consortia are going to spend this large amount of public money, there needs to be accountability arrangements in place,' he says.

Proposals for consortia to involve other health professionals and lay representatives have raised fears among GPs that their commissioning role will be watered down.

Many have argued that it should be left to GP consortia to decide who is represented on their boards.

But Mr Dorrell says that this should not be the case. Nor does he think the NHS Commissioning Board should embed consortia composition into its authorisation process.

Instead, he thinks it should be left to the secretary of state to decide who is represented within consortia.

'I don't think it should be written in primary legislation, as there does need to be some flexibility, so I think it should be through secondary legislation.'

He adds that there is nothing unusual about a Bill needing to be overhauled. 'I've sat on a lot of Bill committees and very few have been so perfect that they are incapable of improvement.'

The government must be open to changes to every part of the Bill, with no aspect of its reforms 'sacrosanct', he says.

But he adds that the process should be driven by policy improvement, not political manoeuvring. Mr Dorrell claims that parts of the health reform debate have become bogged down in detail and are largely irrelevant.

Controversially, he includes the debate concerning the statutory duty of the health regulator Monitor in this category.

'It's a very good example of a debate that exercises a substantial time in the House of Commons but makes very little difference in reality,' he says.

'I don't understand this alleged idea that you can't have integration and competition in the same system. It's rubbish.'

Mr Dorrell is keen to see rapid progress with the reforms.

He is not an advocate of the 'slow down school', warning that the NHS must change quickly to meet the efficiency challenge it faces.

With speculation mounting that the listening exercise could delay the Bill by up to six months, the government may welcome this argument as it seeks to recover lost ground.

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