14 Jun 2011

Major changes to NHS reforms announced

Significant alterations of the Government’s NHS reforms are being published after a review found “deep-seated concerns” about the plans. Gary Gibbon looks at what the changes mean.

Prime Minister David Cameron said that the Government had accepted the “core” changes to its divisive NHS reforms recommended by a panel of health experts.

The Prime Minister, who was addressing doctors and nurses at Guy’s Hospital in London along with Deputy leader Nick Clegg and Health Secretary Andrew Lansley, said “we have listened, we have learned, and we are improving our plans for the NHS”.

Recommendations changes to the Government’s Health and Social Care Bill include –

• Nurses and consultants to be included on the boards of new GP groups responsible for commissioning healthcare services

• Stronger safeguards against a “market free-for-all”, with the regulator Monitor required to protect patient interests and not to promote competition as an end in itself

• Additional safeguards against privatisation and to prevent private companies “cherry-picking” profitable NHS business

We have listened, we have learned, and we are improving our plans for the NHS. Prime Minister David Cameron

• Dropping the 2013 deadline for the introduction of commissioning groups, which will only become operative “when they are ready”.

Mr Cameron again denied that his government had performed a “humiliating” U-turn, and hit back at detractors who had predicted that the plans would lead to little or no change in the NHS.

He said: “You wanted us to make clear that competition isn’t there for its own sake, but to make life better for patients: done. You wanted us to get specialists – not just GPs – on commissioning groups: done. You wanted us to join up the different parts of the NHS, to put integration right at the heart of our reforms: done.”

The Health and Social Care Bill was put on hold earlier this year amid a political and professional backlash over moves to extend competition and hand control of £60bn to GPs.

The three amigos - selling the NHS reforms
Has the NHS revolution really been scrapped, asks Channel 4 News Political Editor Gary Gibbon. Changing the description of the duties and responsibilities of the Health Secretary doesn't make a whole load of difference if the levers for action have all been devolved elsewhere.

It could be argued it's a bit like saying the Scottish Secretary remains responsible for Scotland when many powers have moved to Holyrood.

Read more: The three amigos sell NHS reforms

The NHS Future Forum, appointed to lead a “listening exercise”, published its findings alongside a list of recommended amendments to the flagship policy.

Forum Chairman Professor Steve Field said the NHS would be in a “strong position” to tackle future challenges if the Government accepted its recommendations.

“The principles underlying the bill – devolving control to clinicians, giving patients real choices and control, and focusing on outcomes – are well supported,” he said.

“If the substantial changes we propose are accepted by Government, then I think the resulting framework will place the NHS in a strong position to meet this objective and tackle the pressing challenges in the years ahead.”

Cautious welcome

Dr Hamish Meldrum, Chairman of Council at the BMA, welcomed the announcement of changes to the Bill, but insisted that there was a need for greater clarity on some of the aspects.

“We are pleased that the government has accepted the Future Forum’s core recommendations, and that there will be significant revisions to the Health and Social Care Bill,” he said.

“We welcome the shift in the role of Monitor away from promoting competition. However, while we have always supported the principle of greater choice for patients, it has to be workable. There will need to be robust safeguards to ensure that vital services are not destabilised by unnecessary competition.

“More detail is needed about the way clinical commissioning groups will operate in practice. While greater accountability and transparency around their decision-making processes are welcome, they should not be encumbered by bureaucracy.

“It is reassuring that the government recognises there are still a number of issues to work through. It is particularly important that dialogue continues on education and training and the development of incentives for commissioners.

“We look forward to continuing our discussions with the government to help ensure that NHS reform is best for patients and workable for staff. 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.”