The government has tabled further amendments to its controversial plans for NHS reform as it pushes for Parliament to pass the health and social care bill.
The government has tabled 137 amendments to its health bill. There are no major policy changes but they give some ground to members of the House of Lords who have challenged the government.
Ministers will hope they mean the bill can pass easily when it returns to the Lords for report stage on Wednesday. Report stage will last just over a month.
The amendments include putting “beyond doubt” the health secretary’s accountability and responsibility for providing a comprehensive health service, and promising greater emphasis on patient involvement.
They come after months of disquiet about the bill, with opposition from the royal colleges of nursing and midwives, and other major health unions. Last week, the 20 bodies that make up the Academy of Medical Royal Colleges were divided over the strength of the stance they should take against the bill.
One of today’s amendments says the new NHS Commissioning Board and clinical commissioning groups run by GPs will have new responsibilities to support education and training. Both will also have to report annually on their progress in tackling health inequalities, together with the health secretary.
The regulator Monitor will also have clear powers to require healthcare providers to promote integration of NHS services.
The amendments cover eight main areas:
- Clearer ministerial accountability. Health minister Earl Howe has agreed changes with peers concerned about this area. They include making the health secretary’s duty to promote autonomy subsidiary to main duties - which are also amended - “to promote the comprehensive health service and to exercise their functions so as to secure the provision of services”.
- Education and training – including a new duty on the NHS Commissioning Board and clinical commissioning groups to promote education and training; and strengthening the duties of the health secretary, commissioning board and CCGs to “promote research”.
- Integration and competition – including allowing Monitor to impose conditions on providers’ licences with the intention of, “enabling health care services… to be provided in an integrated way…[or to be] integrated with the provision of health-related services or social care services…[or for] enabling co-operation between providers”. Another change is that in the bill’s proposed seven-yearly reviews of the healthcare sector, the Competition Commission will look at the “effectiveness” rather than “development” of competition
- Health inequalities – including requiring the health secretary, commissioning board and CCGs to report annually on how well they have fulfilled their duties to reduce health inequalities,
- *Patient involvement – changes commissioning board and CCG duties to say they must promote the patient involvement in “the prevention and diagnosis of [their] illness [and] their care and treatment”. The commissioning board must publish guidance on how they do so. The changes have been welcomed by patient group National Voices.
- Another change sets out that HealthWatch England, which will be a committee of the Care Quality Commission, must not be made up of a majority of people from the CQC. It is intended to protect its independence.
- Conflicts of interest – requires all members of committees or subcommittees of CCGs to declare their interests.
- Public health – including that local councils must make directors of public health a “statutory chief officer”, like directors of children’s services and adult social care.
- Patient confidentiality – limits use of the NHS Information Centre’s new powers to collect, analyse and publish information. The information centre will also publish a code of practice for organisations dealing with person-identifiable information.
Health secretary Andrew Lansley said: “The principles of our modernisation plans – ‘no decision about me, without me’ for patients, clinical leadership with doctors and nurses leading discussions on services, a focus on results for patients and reducing bureaucracy - have always been at the core of the bill.
“These principles are widely accepted as reported by the independent NHS Future Forum. But we have been carefully listening to the ideas raised as the bill has progressed through Parliament.
“And as a result we have today tabled a series of amendments to address these remaining issues.”
But RCN chief executive and general secretary Peter Carter said: “While we welcome the government’s decision to look again at aspects of the bill, these amendments are merely tinkering around the edges.
“They do not go anywhere near far enough and fail to resolve the fundamental concerns that the RCN has about the health and social care bill. We still feel the reforms are creating such turmoil that they must be stopped,” he said.
“In particular, the amendments do not fully address the key areas of competition, nurse involvement, the private income cap and health inequalities. The bill continues to damage the NHS as we know it and combined with the need to save £20bn in England by 2014, we fear that the health service is facing an extremely difficult future.”