Will the DoH accept changes to the Bill?

Why is the Health Bill on hold and will the DoH change its plans for reforming the NHS? Susie Sell reports

Dr Wollaston: the Bill could not have been passed in its current form (Photograph: South Devon Conservatives)
Dr Wollaston: the Bill could not have been passed in its current form (Photograph: South Devon Conservatives)

Six months after consultations closed on plans set out in the White Paper Liberating the NHS, the government says it is back in listening mode.

The plans, now shaped into the Health Bill, have made it through two readings in the House of Commons and scrutiny by a committee of MPs.

So what has prompted the government to launch a 'listening exercise', with a promise from prime minister David Cameron that although he believes the NHS must modernise to survive, the government is prepared to amend its plans?

Health secretary Andrew Lansley said last week that the review will focus on the role of choice and competition and how non-NHS providers can support the health service.

It will also look at how to ensure public accountability and patient involvement, and how changes to education and training can support the reforms.

King's Fund chief executive Professor Chris Ham says the listening exercise is a 'very helpful and sensible move'.

Burgeoning concerns
It shows the DoH has taken on board the burgeoning concerns raised by the profession and from within 'the heart of the government', he says. 'This is very unusual. I can't think of any other example of this,' he says. 'It signals the depth of concerns that people have.'

Former GP and Tory MP Dr Sarah Wollaston believes the decision to put the Bill on hold came simply from a recognition that it would not have been passed in its current form.

GPC deputy chairman Dr Richard Vautrey agrees. The next stage for the Bill is a third reading in the Commons, after which it will be passed to the Lords.

Peers were 'setting themselves up to give the Bill a mauling', Dr Vautrey says. 'This is a complex Bill and many MPs and peers have taken time to get full understanding of the implications,' he says. 'That's why we are only now seeing disquiet becoming magnified.'

GP leaders are clearly relieved that the government has paused to take stock, and that the Bill did not continue to be bulldozed through parliament.

The GPC says it hopes to use the pause in the Bill's passage to engage with the government, focusing on concerns about Monitor, the NHS Commissioning Board and the drive to increase competition.

The RCGP says it stands by its concerns around competition, fragmentation and accountability and hopes that the government will act on the profession's concerns. But is it realistic to think the government will now be prepared to water down proposals?

Professor Ham says there will be disagreement within government about what should be done and how radical the changes should be.

'Nick Clegg is arguing that the changes must be substantial and I'm sure Andrew Lansley will not want to make massive changes at this stage because he is so closely associated with the Bill,' he says. But Professor Ham warned it would be a 'political disaster' if the government only made cosmetic changes to the Bill.

'If you add together all the issues being raised by stakeholder groups, a strong case can be made to have a serious rethink,' he says. 'We have taken an unprecedented step to consult during the Bill's passage through parliament. That would backfire on the government if major changes are not made.'

The government has said the pause in the Bill will allow it to look at choice and competition and how education and training can support the reform process.

It will also look at how a range of health professionals can improve patient care - suggesting an appetite for considering Commons health select committee advice that consortia should not just comprise GPs.

Overhauling the Bill
But if the government is really going to look at overhauling the Health Bill, how will this impact on the overall timeframe of the reforms?

Speaking in the Lords, health minister Lord Howe said the exact duration of the pause has not been fixed, and will depend on the volume of feedback. But he predicted the Bill would move to the Lords before the July summer recess.

'That statement does come with what I might call a health warning,' he said, 'because we are clear that we want to listen to the opinions of everybody who counts in this.'

Professor Ham says the Bill is still likely to become law by the end of the year.

The coming weeks will be crucial for the NHS reforms. The DoH must now manage a difficult balancing act: changes to the Bill must go far enough to appease angry health professionals and the Lords, but not so far that they kill off the enthusiasm of GPs in consortia who are already making great strides forward.

  • January 2011 - Health Bill published.
  • February - House of Commons second reading.
  • March - Committee stage ends.
  • April - Listening exercise begins.
  • Third Commons reading, passage to House of Lords - by July?
  • Bill becomes law - by December?

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