Further 'delay' over NHS changes

Doctor The government's changes have been put on hold

The deputy prime minister has suggested further delaying plans to change the way the NHS in England is run.

In a speech in London, Nick Clegg said he wanted MPs to be given another chance to scrutinise the health bill once concessions are made next month.

Mr Clegg also gave a strong signal of what those steps may be, including less of an emphasis on competition and a more relaxed approach to the timetable.

Earlier the British Medical Association called for the bill to be withdrawn.

The NHS reforms have been on hold for the past six weeks while the government carries out a listening exercise.

But with that coming to an end, the deputy prime minister set out the direction the government was heading to an audience of health staff and campaigners.

Competition

Mr Clegg said competition would still have a role to play, but said the primary duty of the regulator would be to protect patients and promote collaboration.

He added in areas where competition would be beneficial to patients it would be done in a managed way.

Analysis

The NHS listening exercise is only just coming to an end, but already it is becoming clear what direction ministers are heading.

As expected, it is a compromise, which the government is hopeful will be enough to satisfy critics without undermining the coalition.

It appears competition is not being thrown out altogether, but nor is it quite being given the priority it was originally.

The foot is also being taken off the accelerator with GPs no longer facing an absolute deadline to take on the extra responsibilities.

Coupled with a number of other concessions, the government is now quietly confident it can get its reforms through - even if that means having to jump through some of the parliamentary hurdles it has already negotiated.

Nonetheless, the next month promises to be pivotal. The government will set out in detail what it plans to do in the next few weeks and then at the end of June hundreds of doctors will gather for their annual conference where they will give their verdict.

He also said the duty on the health secretary to provide a comprehensive health service would be retained.

What is more, the big bang approach looks like it will be relaxed. GPs were due to take charge of budgets by 2013 under the original plans, but Mr Clegg said NHS managers would be retained to support them in areas where they were not ready.

Mr Clegg said it was important to introduce the changes in a "planned and phased way".

"We are going to tread carefully, but we are not going to shrink from what needs to be done," he added.

He conceded changes on this scale would require the bill to be sent back to repeat its committee stage - effectively putting the parliamentary process into reverse.

"I don't think it would have been right for us to have held this listening exercise, to make big changes to this legislation and then seek to bounce it through.

"I think it is very important that MPs who are accountable to millions of patients up and down the country have the opportunity to really look at the details that we are proposing and that's why I think we will need to send the bill back to committee."

The BMA had put pressure on ministers to take the drastic step of withdrawing the bill in its submission to the listening exercise which it published on Thursday.

The doctors' union had called for a wide range of concessions, some of which Mr Clegg mentioned.

Nick Clegg: "We need a health service that can survive in lean times as well as plentiful ones"

His speech was given a cautious welcome by the union.

Dr Richard Vautrey, of the BMA, said it was "reassuring" that the government was recognising some of the problems that had been raised.

But he added: "Real evidence of their commitment to listen will not come until we learn more about their plans for the bill."

Mike Farrar, chief executive of the NHS Confederation, which represents managers, added: "We are encouraged by the speech, which suggests that the listening process is beginning to move in the direction the NHS wants. Both the overall narrative and policy content appear to reflect the views we have put forward."

But shadow health secretary John Healey said there was a risk the concessions when finally unveiled - probably in the next few weeks - will amount to a "political fix" that would not be in the best interests of the health service.

He also said the pause reflected badly on David Cameron himself.

"Whatever he decides to do with his NHS plans, this first year has raised serious questions about the prime minister and his government's judgement, competence, values and integrity."

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