Nick Clegg is expected to propose further amendments to the Health Bill over the next few weeks as he attempts to appease his party over the scale and pace of the reforms, writes Victoria Macdonald.
On Tuesday night, the Deputy Prime Minister presented a page-long document to the weekly meeting of his parliamentary party in which he singled out the role of Monitor, the NHS regulator, as the area of the Bill needing the most substantial change.
The document, which was later leaked, suggests removing all references to Monitor being an economic regulator.
“Instead of having a duty to promote competition, Monitor’s main duty should be explicitly to protect and promote the interests of patients,” Nick Clegg wrote.
He said the decision to establish it as an economic regulator was clearly a misjudgment and that the NHS could not be treated as if it were just a utility “like electricity or telephones”.
But his party has tabled more than 21 substantial amendments to the Bill and while Mr Clegg has picked out one of the key elements, which goes to the heart of the legislation, Lib Dem insiders say they expect him to deal with issues such as accountability of the commissioning boards, and conflicts of interest where GPs buying care for patients also have financial interests in companies providing treatments.
Tears before teatime
Roy Lilley, NHS expert, explained the key problems with competition in the health service to Channel 4 News.
"There are lots of services in a hospital like hip operations and hernias. These could be done in the private sector. But the revenue from these cross-subsidises expensive and tricky things, like paediatrics, A and E, pathology.
"But if you take hip operations away, you carve out huge chunks of money from the NHS, and destabilise the system. You can't let competition loose in the NHS. There will be tears before teatime."
Read more from Roy Lilley on how the NHS is now a battle over politics, not patients
Mr Clegg faced a grassroots rebellion at the Liberal Democrats‘ Spring Conference over key elements of the reforms and shortly after the “pause” in the passage of the Bill was announced and the listening exercise.
His latest statement is not thought to have troubled Downing Street too much and the Health Secretary Andrew Lansley has also said in recent months that the emphasis needed to be on quality rather than competition.
Labour today claimed Mr Clegg was trying to shore up his position following his party’s dismal results in the local elections. A Labour health spokesman said that Mr Clegg had led the party through the second reading of the Bill and that Lib Dem MPs had voted against almost 100 amendments tabled by Labour during the Bill stage. They plan to release a “compare and contrast” list of the amendments they had proposed and those tabled by the Lib Dems.
The crucial point for Mr Clegg will be when the parliamentary timetable for the Bill resumes and whether it will be vetoed by Lib Dem MPs as they have threatened unless their “required amendments” are met.
Click on the image above to read more from Channel 4 News on the NHS reforms