NHS bill: Government wins key vote in House of Lords

Earl Howe opens the NHS bill debate Earl Howe said a vote to delay "could well prove fatal" to the Health and Social Care Bill

The government's controversial NHS bill for England has cleared a crucial hurdle after peers rejected a proposal to send it for further scrutiny.

The House of Lords voted 330 to 262 against an amendment which would have referred parts of the bill to a special select committee.

Health Minister Earl Howe said it could be altered further to address concerns, but any hold-up could "prove fatal".

Peers have also rejected an amendment to block the bill altogether.

That amendment was put forward by Labour peer and former GP Lord Rea, who argued it was never a manifesto commitment by either the Conservatives or the Liberal Democrats.

It was rejected by 354 votes to 220.

The Health and Social Care Bill - which will now proceed to a normal committee stage in the Lords - would increase competition and put GP-led groups in control of buying care in their areas.

Ministers say the changes are vital to help the NHS cope with the demands of an ageing population, the costs of new drugs and treatments and the impact of lifestyle factors, such as obesity.

Analysis

Two battles won, a war still to fight - these much debated changes to the NHS still have a long way to go. Labour failed to kill the bill, but they were never likely to succeed.

Lord Owen's idea of an extra committee, which could have meant extra delay, was also defeated.

But winning votes is one thing, changing noble minds quite another.

Plenty of peers fear the bill could make the Health Secretary less responsible and less accountable for the health service.

Some of them want more changes when they get to discussing the details. The government has hinted they may get them.

And could Labour try to create yet more delays? They say that is not their plan but government whips will keep a close eye on anyone attempting to talk the bill to death.

They say the bill, which has already been substantially altered following criticism from NHS staff and Liberal Democrat MPs, now has wide support.

But leading medical professionals have warned that the proposals are still unpopular.

"Choice is fine but to have choice ahead of quality and delivering consistent healthcare, seamless healthcare for patients, is going to result in a chopped-up health service with little bits competing with other little bits," Dr Laurence Buckman, a senior representative from the British Medical Association, told BBC Breakfast.

Labour's shadow health secretary Andy Burnham said the "fight" over the bill would go on, despite the vote on Wednesday.

"It will be debated now over a number of weeks, even months, in the House of Lords - line by line, clause by clause - and Labour will be wanting changes to this bill, substantial and drastic changes to it, so this is far from over," he told the BBC.

Andy Burnham: 'It's a sad day for the NHS'

"The government are digging in here, they're digging in for the long haul and that's not going to help our National Health Service."

The amendment calling for referral to a special select committee, which allows witnesses to give evidence, was tabled by two crossbench peers - Lords Owen and Hennessy.

They said the bill raised serious constitutional issues, particularly aspects relating to the role of the health secretary in overseeing the NHS and the role of the regulator, Monitor, in promoting competition within it.

'Shopping'

Lord Owen argued a special select committee was the only way of looking at "the complexity of this new relationship we are trying to establish" between patients, clinicians and the secretary of state.

"Health is not a public utility," he warned. "Health is different."

Lord Owen insisted his was not a "wrecking" amendment and said his select committee would complete its scrutiny by 19 December - in good time for the bill to complete its usual stages.

Health and Social Care Bill

  • Jan 2011: Commons First and Second readings. Approved with no rebellions
  • Feb - Mar: Commons committee stage, various amendments accepted on competition
  • 4 April: Bill "paused" following widespread criticism
  • April - June: "Listening exercise" conducted by NHS Future Forum
  • June - July: Bill sent back to Commons committee stage. MPs approve further amendments prompted by listening exercise
  • 6 - 7 Sep: Commons report stage and Third Reading - approved with four Lib Dem rebels
  • Sep: Bill arrives in the Lords
  • Oct 12: Lords reject bids to block the bill altogether and to send parts of it to a special select committee
  • Christmas? Ministers would like the bill to get royal assent by then but even without further delays, there are still several stages to go through
  • April 2013? Further delays notwithstanding, NHS commissioning groups due to take charge of budgets then

Labour supported the amendment, and Baroness Thornton, who leads for them on health in the Lords, said the bill would turn "patient choice into shopping", while healthcare would become a "traded commodity".

However, for the government, Lord Howe, told peers the proposed changes would "liberate the NHS" and improve patient care in England.

"The bill does not do anything that might or could lead to the privatisation of the NHS," he said, summing up.

The minister said he was considering amending the bill to require Foundation Trusts to publish details of how their non-NHS earnings were benefiting NHS patients.

He said he was also tabling an addition to the bill on the duty of the secretary of state in relation to the education and training of NHS staff.

Lord Howe insisted any further delay at this stage could risk the entire legislation - which ministers want to become law by the end of the current parliamentary session next April.

"The House must have proper time to examine the bill but the proposal put forward by Lord Owen could result in delay, which could well prove fatal to it," he said.

And former health minister Lord Darzi, who wrote a report on the future of the NHS for Gordon Brown, has said the health service "must embrace change" or risk "falling back".

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