World News Today: PM agrees major NHS concessions

Tuesday, June 14, 2011

PM agrees major NHS concessions

Professor Steve Field, the former head of the Royal College of GPs who led the NHS Future Forum

Professor Steve Field GP, who led the forum: 'Competition isn't the be all and end all'

Ministers will seek to reinvigorate plans to change the NHS in England after an independent review recommended a major rewrite of the proposals.

The government is to promise to slow the process of giving more purchasing powers to GPs, as it attempts to heal divisions between Tories and Lib Dems.

It is hoped this will allow the changes to pass into law before Parliament adjourns for the summer recess.

Ministers hope a quick response will allow them to restart stalled changes.

The proposals for the NHS have become an increasing source of tension between the Conservatives and Liberal Democrats

Many Lib Dems have complained that handing GPs control of much of the NHS budget and opening up services to greater competition could lead to effective privatisation of services.

At the party's spring conference, members voted to amend what they called a "damaging and unjustified" programme of change.

But many Tories say reform is needed to provide better value for money and improve services.

In April - amid fears of a rebellion by Lib Dem MPs and peers, and following criticism from academics and health unions - the government took the unprecedented step of halting the parliamentary progress of the Health and Social Care Bill.

A panel of experts, called the NHS Future Forum, was set up to review the policy.

Its report, published on Monday, recommended a wide range of changes. The BBC understands many of those will now be accepted, including:

The legal responsibility of the health secretary for the NHS to be reinstatedThe 2013 deadline for the new arrangements to be relaxed. Commissioning groups will have to be established, but those not ready will not have to take on responsibility for the budget. Instead, the national board in London will take charge in those circumstancesThe power of health and well-being boards, which are being set up by councils, to be beefed up. Patients also given a greater role on them to ensure the patient voice is heardGPs still taking the lead in making decisions through the commissioning groups, but other professionals such as hospital doctors and nurses to be consulted more

Ministers had originally wanted to hand GPs control of much of the NHS budget, while opening up the health service to greater competition.

However, it is not yet clear what the government will do about the recommendations the forum made about this.

It suggested that, while GPs should remain in control, they should consult other professionals.

Analysis

Accepting the recommendations in full would not represent a major climbdown for the government.

Even on the most controversial element - competition - the NHS Future Forum was clear. It has an important role to play.

Instead, many of the proposals are about moderating language.

The term economic regulator should be dropped because it makes the NHS sound like a utility industry not because it is fundamentally wrong, according to the forum.

There are extra safeguards being proposed as well to ensure the policy does not lead to unintended consequences.

But the general direction of travel remains the same. That is to say, doctors are to be given more of a say in decision-making and the private sector is to get greater involvement.

That does not mean that this review - and any government response to it on Tuesday - represents simple tinkering.

As the review team made clear there were "genuine and deep-seated" concerns.

Greater clarity was needed and in giving this, as one member of the review team has been saying, some of the rough edges will hopefully be smoothed away.

The BBC understands the government will not be explicit on whether all GP groups will be compelled to take on control of budgets and planning.

The Department of Health says the aim and expectation is that all groups will take the powers on eventually - but at this stage it is not planning explicitly to compel them to do so.

Department of Health sources admit that leaves the Lib Dems free to suggest that GPs could ultimately refuse to take on control of budgets and planning.

Senior Lib Dem sources have suggested to the BBC that GP commissioning will therefore still be voluntary.

The review also proposed a greater balance between competition and co-operation among NHS hospitals, charities and private firms.

The focus on competition - perhaps the most controversial element of the plans - needed to be "significantly diluted", it said.

Originally, the regulator - Monitor - was to have a primary duty to promote competition, but that is likely to be dropped along with the term "economic regulator", which the forum said made the NHS sound too much like the gas or electricity industry.

Instead, Monitor should focus on ensuring patients have choice to drive up standards. While competition had a role to play, so did collaboration and integration, the forum said.

Sir Richard Thompson, president of the Royal College of Physicians, said the forum's changes to competition were a "step in the right direction".

Dr Hamish Meldrum, chairman of British Medical Association, said the government's approach during the listening exercise had been "refreshing", but this needed to be maintained in the coming months.

Professor Steve Field, the former head of the Royal College of GPs who led the Future Forum, said while the principle of putting doctors in charge was well supported, he had heard "genuine and deep-seated concerns" from many.

"If the substantial changes we propose are accepted by government then I think the resulting framework will place the NHS in a strong position."

Speaking ahead of the full government response, Health Secretary Andrew Lansley said the group had been an "invaluable source of expert advice".

But, for Labour, shadow health secretary John Healey called the Future Forum report a "demolition job on the Tory-led government's misjudgements and mishandling of the NHS over the past year".

The BBC understands that ministers are hopeful the report and the government response will allow them to press ahead almost immediately with the programme.

Officials are working on the basis that amendments could be made to the bill within weeks, allowing the government to kick-start the parliamentary process before the summer.

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