Health changes radically revised and delayed

14 Jun 11
The government has accepted the recommendations of the consultation into its controversial NHS reforms, stating that there will be 'evolution, not revolution' in the health service.

By Richard Johnstone | 14 June 2011

The government has accepted the recommendations of the consultation into its controversial NHS reforms, stating that there will be ‘evolution, not revolution’ in the health service.

Cameron, Clegg and Lansley announce NHS reforms

Among the changes announced today is the scrapping of the April 2013 deadline for the creation of the new commissioning groups. In addition, these groups, which were to be GP consortiums, will now be ‘clinical commissioning groups’, including a wider range of health professionals such as nurses and specialists.

The new plans were announced by Prime Minister David Cameron, Deputy Prime Minster Nick Clegg and Health Secretary Andrew Lansley at Guy's Hospital in London.

They said the new groups will take charge of commissioning when ‘they are ready and able’, with a national NHS Commissioning Board taking the role until the local consortiums are ready. The groups will now meet in public.

Alongside these, ‘clinical senates’ will be created to bring together clinical knowledge in wider areas, Lansley said. The new health care regulator Monitor will be given a ‘core duty’ to protect and promote patients’ interests. This and other changes match the recommendations made yesterday by the NHS Future Forum, which led the consultation on the original controversial reforms contained in the Health & Social Care Bill.

Lansley said there would also be a phased approach to the introduction of the ‘any qualified provider’ provisions, which will allow increased competition in the provision of health services. The extent of competition will also be decided by those commissioning care, not imposed, he added. Originally, Monitor, currently the independent regulator of foundation trusts, was to be given a duty to promote competition.

Monitor chair David Bennett said he welcomed the ‘clarity over the government’s plans, saying it was absolutely right’ that the regulator had a clear role to put patients first.

The government has said the revised Bill will have ‘stronger safeguards against a market free-for-all’. Clegg said: ‘Privatisation by the back door is impossible. It will be illegal to favour any private provider, or any provider, over any other. We are putting integration at the heart of our reforms, at the top of Monitor’s agenda.’ Any competition will be on quality, not price, he said.

Local health and wellbeing boards will be strengthened, giving them stronger powers to hold commissioners of both local NHS and social care services to account if their commissioning plans are not in line with an agreed joint health and wellbeing strategy.

The Health & Social Care Bill, which was put on hold in April for the consultation, will now return to the Commons. It will be recommitted to committee stage to allow MPs to examine the changes, Clegg confirmed.

Prime Minister David Cameron said that the plans would also look to break down barriers in the health service. He said: ‘We’ll be exploring ways to bring the different pots of money together across health and social care.’

But Unison general secretary Dave Prentis said the government was ‘creating a Frankenstein Bill that should be thrown out’.

He added: ‘The government is creating a monster and the NHS is the victim. The Bill will pave the way for private companies to grab any part of the NHS where they think they can turn a profit.  Once the NHS is opened up to competition, it becomes subject to European Competition laws and there is no turning back.’

Another trade union, Unite, also said that private health care firms ‘will use European Union law to gain a headlock on the NHS’ as a result of the competition provisions in the Bill.

The British Medical Association said it was ‘pleased’ that the Future Forum’s core recommendations had been accepted.  

BMA chair Dr Hamish Meldrum said: ‘We will need to look carefully at the details of the changes, but it seems clear that what we are likely to see is a very different Bill, and one which puts the reforms on a better track. There is much in the government’s response that addresses the BMA’s concerns, and many of the principles outlined reflect changes we have called for.’ 

He added: 'Hanging over all this, however, is the fact that the NHS is facing unprecedented financial pressures. The focus on structural reform must not distract us from the task of minimising the impact of funding cuts on care.’ The NHS is required to make efficiency savings of £20bn between 2011 and 2015.

The Local Government Association said it was ‘reassuring’ that the government had listened to calls to integrate health and social care.
David Rogers, chair of the LGA's community wellbeing board and member of the Future Forum, said the requirement for commissioning groups to share and agree plans with wellbeing boards, publish board papers and hold public meetings were also positive steps. ‘This should help avoid communities being dictated to from above and see people genuinely involved in decisions made about themselves or their loved ones.’

The NHS Confederation said the government had ‘responded positively to what the NHS wanted’.

Chief executive Mike Farrar said: ‘All through the listening exercise we have advocated a more intelligent approach to the issue of choice and competition, and its impact on integrated care. We are pleased to see that the government has recognised the importance of promoting integration but believe it is also important to recognise that for some services the use of choice and competition is also an essential route to deliver the best patient care.’

The CBI’s director of public services, Susan Anderson, said the government ‘should not underestimate the important role that competition can play in delivering patient choice’.

She added: ‘All providers, whether they are in the public, private or third sector, should be able to compete to deliver high-quality services.’

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