The Health and Social Care Bill is back in the Public Bill Committee after a period of reflection and review and it is therefore worth reflecting on an extraordinary few months for the Government’s flagship Bill. While the period of reflection was welcome, it does now seem extraordinary that consideration of the amendments is to be shoe-horned into a period of less than three weeks without a consolidated version of the Bill being available for consideration. A Bill that was six years in the making is now to be reshaped in less than three months. Clearly, the less radical the Bill becomes the more the need for this top down reorganisation could be queried.

‘Pause Listen and Reflect’  

The Health Secretary, Andrew Lansley, announced on Monday 4 April 2011 that there would be a break in the passage of the Health and Social Care Bill. The Bill had received its second reading on the 31 March 2011 and had completed its committee stage in the House of Commons on 31 March 2011. The Bill at the date of the break took the following form Health and Social Care Bill at 4 April.

NHS Future Forum  

Following the announcement, the Government set up the NHS Future Forum to review the Health and Social Care Bill under the Chairmanship of Professor Steve Field and consisting of 45 members. The group reported its findings and recommendations to the Government on Monday 13 June 2011. The Forum made 16 key recommendations including the following:

  • the pace of the proposed changes should be varied so that the NHS implements them only where it is ready to do so;
  • the Secretary of State for Health should remain ultimately accountable for the NHS;
  • nurses, specialist doctors and other clinicians must be involved in making local decisions about the commissioning of care – not just GPs – but in doing this the NHS should avoid tokenism, or the creation of a new bureaucracy;
  • competition should be used to secure greater choice and better value for patients – it should be used not as an end in itself, but to improve quality, promote integration and increase citizens’ rights;
  • the drive for change in the NHS should not be based on Monitor’s duty to ‘promote’ competition, which should be removed, but on citizens’ power to challenge the local health service when they feel it does not offer meaningful choices or good quality; and
  • all organizations involved in NHS care and spending NHS money should be subject to the same high standards of public openness and accountability.  

A copy of the report can be obtained at NHS Future Forum Recommendations.

The Government’s response

On 14 June 2011 the Health Secretary announced changes to the Health and Social Care Bill based on the recommendations from the NHS Future Forum. The Health Secretary’s response is available at Government Response to NHS Future Forum Report. The Government has largely accepted the NHS Future Forum’s recommendations. In broad terms, accountability will be enhanced, competition down graded, integration promoted and the timetable for trusts to become FTs and for the establishment of Clinical Commissioning Groups relaxed.

Public Bill Committee  

On 21 June 2011 the House agreed a programme motion re-committing certain clauses to the Public Bill Committee with the intention to deal with the changes prior to Parliament rising on 18 July 2011. Most of the recommitted clauses are in Part 1 (the Health Service in England), Part 3 (Economic Regulation of Health and Adult Social Care Services), Part 4 (NHS Foundation Trusts) and Part 5 (Public Involvement and Local Government).

Details of the amendments proposed are available at Amendments. The Government has published Briefing Notes on the changes proposed by it although the notes do not include the amendments themselves. Not surprisingly, the Opposition is arguing that the whole Bill should be recommitted which would of course mean a new Bill procedure and the Government is unwilling to do this. Whether this approach will give rise to the renewal of trust the Government is seeking remains to be seen especially as the amendments proposed to date do not appear in all cases to reflect the more general announcements by the Health Secretary to Parliament. Among the changes, flagged by Simon Burns, Health Minister, to the Committee on 30 June, the Commissioning Consortia will now become Clinical Commissioning Groups and are beginning to look more and more like the PCTs they replace. A further note on the Bill will appear once the Bill is republished following the Public Bill Committee stage. Our previous briefing is available at Health and Social Care Bill Briefing January 2011.