Cameron backs wholesale changes to NHS plans

The Prime Minister set out five main points in which he said patients would benefit from the reforms

David Cameron has agreed to make major concessions on his plans for the NHS in England, but insisted the government had not made "a humiliating U-turn".

Ministers have accepted all the changes suggested by a panel of experts, including more controls on competition and a slower pace of change.

Labour said the original proposals had been "demolished", but Mr Cameron said the "fundamentals" had been retained.

Doctors' groups have broadly welcomed the revisions.

The NHS bill will now go back to the committee stage in the House of Commons to be scrutinised again by MPs before going through its House of Lords stages.

The prime minister's official spokesman said he expected that to happen before the summer recess begins in July, and the bill to be on the statute book by the end of the current Parliamentary session.

That gives ministers until May 2012 to make it law.

Ageing population

On Monday - following a 10-week "listening exercise" - a panel of experts called the NHS Future Forum gave its recommendations on the changes needed to the bill.

They include:

  • Reinstating the legal responsibility of the health secretary for the overall performance of the NHS
  • Scrapping the primary role of the regulator, Monitor, to promote competition - and focusing on improving patient choice instead
  • Relaxing the 2013 deadline for new GP commissioning arrangements to be introduced - a National Commissioning Board, based in Leeds, will control budgets until GP groups are "able and willing" to take over
  • Strengthening the power of health and well-being boards, which are being set up by councils, to oversee commissioning and giving patients a greater role on them
  • Retaining a lead role for GPs in decision-making, but boosting the role of other professionals such as hospital doctors and nurses alongside them

Analysis

After criticism from medics and complaints from rebellious MPs, the Coalition will be hoping the dust will now settle over its NHS reforms.

If politics is the art of persuasion, then the test for Messrs Cameron, Clegg and Lansley is whether or not they have convinced people that the listening process has been, as the prime minister claimed, a sign of strength.

Or does it, as Labour have been saying today, demonstrate incompetence, the result of a bureaucratic shake-up which nobody voted for?

The debate may now go quiet.

But remember that these reforms were introduced after record levels of public satisfaction in the NHS.

So, if waiting times go up, if the NHS ends up needing an extra bail-out, if patients notice things are changing for the worse, then the government's powers of persuasion may face an even bigger test.

The government and many health professionals believe changes to the NHS are necessary to deal with the demands of the ageing population, cost of new drugs and lifestyle changes such as obesity.

But the issue has led to rifts within the coalition, which have deepened since the Lib Dems overwhelmingly rejected the original reforms at their spring conference.

Mr Clegg had vowed to block any proposals he was unhappy with - and on Monday night he was reportedly cheered by his MPs when he told them their demands had been "very, very handsomely met".

However, at a joint press conference with the prime minister and Health Secretary Andrew Lansley, Mr Clegg said he believed the government now had a plan "we can all get behind".

"Change will happen, but it will happen at the right pace and that is why the arbitrary deadlines have gone," he said, adding that ministers made "no apology" for pausing to "get things right".

Mr Cameron said those who described the reworking of the plans as "a humiliating U-turn", or the listening exercise as "a big PR stunt", were both wrong.

"The fundamentals of our plans - more control to patients, more power to doctors and nurses, less bureaucracy in the NHS - they are as strong today as they've ever been," the PM said.

"But the shape of our plans, the detail of how we're going to make all this work, that really has changed as a direct result of this consultation. "

'Wasting billions'

Mr Lansley admitted he had got some of the proposals wrong, but said he still believed the reworked plan could deliver his ambition of an NHS with a quality of service and level of results that was "the envy of the world".

Start Quote

We have put competition back in its box with regards to this bill”

End Quote Paul Burstow Care Services Minister

The health secretary has faced personal criticism for his inability to garner widespread support for the original bill, but the prime minister said he accepted full responsibility for what had happened.

"I am every bit as responsible as Andrew Lansley for the fact that we actually decided we could improve on what we already put forward," Mr Cameron said.

But Labour leader Ed Miliband singled out the prime minister personally for criticism, saying: "David Cameron should never have rushed into reforms that weren't properly thought through and didn't command the confidence of the medical profession.

"The problem now is that he's still going ahead with a bureaucratic reorganisation that's going to waste billions of pounds."

The British Medical Association said it was pleased the government had accepted the Future Forum's recommendations and addressed many of doctors' concerns.

But it said more detail was needed on how commissioning of care would work in future and there must be "robust safeguards" to prevent competition of any kind destabilising the health service.

The Chartered Society of Physiotherapy said it remained "deeply concerned" at the government's determination to increase competition and diversity of providers in the NHS.

But Lib Dem health minister Paul Burstow told the BBC competition would not be "an end in itself" and would only be used to improve patient choice.

"I think what people should be pleased about is that we have put competition back in its box with regards to this bill," he added.

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