Clegg pledge over NHS shake-up concerns

Deputy Prime Minister Nick Clegg has promised to address concerns over the Government's controversial NHS reforms as MPs called for "significant changes" to the plans.

The cross-party Commons Health Committee urged a rethink of the proposals, with former Tory health secretary and committee chairman Stephen Dorrell saying it is not a case of merely recommending "minor tweaking" of the Health and Social Care Bill.

One of the points the committee stressed is that GPs should not be solely in charge of commissioning services for patients. However, Mr Clegg said he believed it was an "uncontroversial idea" to hand them more responsibility.

He told BBC Breakfast: "It is a rather good idea to have them in the driving seat, rather than unaccountable officials who are moving money around from one side of the desk to the other.

"But, yes, with responsibility must come more accountability, which is precisely why we will be looking at these concerns, and will be looking to amend the legislation to reflect that."

The Liberal Democrat leader said they would listen to "legitimate" concerns about the Bill, currently going through Parliament, and that there could be "substantial" changes to the legislation.

Mr Clegg said: "The NHS is not the Government's property. We want people to feel comfortable with the changes, which will strengthen, and not weaken, the NHS."

He added that "a number of very significant amendments and improvements" had already been made to the Bill.

Addressing concerns about competition, he said: "There isn't going to be a bargain-basement rush to the bottom, because there isn't going to be competition based on price."

Mr Clegg added: "We want to be very, very clear - we're not going to allow cherry-picking.

"We're certainly not going to allow vital parts of the NHS, like A&E, to be suddenly open to competition."

MPs on the committee recommended a much bigger role for nurses, specialists and social care chiefs in deciding how services should be designed, together with tighter systems of governance and accountability.

All NHS commissioners - who would be GPs under the Bill's proposals - should have a board chaired by an independent person as well as a chief executive and finance director, they recommended.

The boards should be forced to meet in public, and measures put in place to ensure no conflict of interest as a result of GPs commissioning services from private firms in which they have a stake.

The name "GP consortia" to represent groups buying services should be scrapped, and renamed "NHS Commissioning Authorities", their report said.

This would reflect an expanded role for other health professionals in commissioning, including nurses and hospital doctors.

As a result of the changes put forward by the committee, Health and Wellbeing Boards in the Bill could be scrapped, the report said.

The committee also called for commissioners to have a legal obligation to consult patients through HealthWatch, an organisation designed to ensure local views are taken into account.

Their report today comes as Mr Clegg and Prime Minister David Cameron prepare to launch a "listening exercise" this week in a bid to reassure critics of the shake-up.

Health Secretary Andrew Lansley has admitted some groups have "genuine concerns" about the plans, including the speed of the changes, and was forced to make a Commons statement yesterday to defend aspects of the Bill.

He said the Government would take the opportunity of a "natural break" in the passage of the Bill to "pause, listen and engage" over the concerns and bring forward amendments to "improve the plans further".

Labour leader Ed Miliband has branded the Government's health reforms "extremely dangerous", and unions are opposed to many parts of the Bill, particularly those which aim to promote more competition between the NHS and private companies.

Mr Dorrell said there had been "spirited discussions" among committee members about competition in the NHS, but they all agreed commissioners and patients should have choices.

He said the changes set out in the report would create structures which were "more fit for purpose", and would help meet the Government's demand that the NHS find £15 billion to £20 billion a year in efficiency savings.

It was "beyond argument" that groups of commissioners, each responsible for roughly £20 million of taxpayers' money, should have proper governance and be held fully accountable, he said.

And he argued that calling commissioning bodies "GP consortia" was "misleading" and "over-emphasised" the role of GPs.

Furthermore, it was "odd for a Government that wants to encourage local decision-making" to produce a Bill where local bodies would not have any power. Of the report's content, he added: "I do accept that this is not minor tweaking."

The Royal College of Physicians (RCP) welcomed the report, saying it hoped the Government adopted the recommendations.

The RCP has been calling for hospital doctors, public health specialists, nurses and local community representatives to sit alongside GPs in NHS commissioning.

President Sir Richard Thompson said: "The RCP welcomes the report and wants to see 'commissioning without walls' - where a broad range of clinicians are fully involved in the commissioning process.

"However, although the Government supports this, currently the Bill provisions are too loose, leaving involvement of clinicians dependent on local relationships alone.

"Without further specific legislation, there is a risk of fragmentation of services and damage to patient care."

Cathy Warwick, general secretary of the Royal College of Midwives, said: "GPs are highly qualified but are on the whole generalists. To commission services effectively and appropriately they will need the expertise and input of people who know their particular field.

"I would, though, have liked to see midwives referenced specifically as one of those key professionals."

Nigel Edwards, acting chief executive of the NHS Confederation, said: "We absolutely agree with the committee's view that the accountability of GP consortia must be radically improved.

"We need a comprehensive and clear governance structure that has the confidence of patients and the public."

Len McCluskey, general secretary of the Unite union, said: "The committee raises profound questions about the Government's competence when it comes to the NHS. It rightly warns that massive £20 billion cuts to health spending at a time of rising care demands is a fundamental challenge to the NHS's operations."

Dr Peter Carter, chief executive of the Royal College of Nursing (RCN), said: "We have long said that no single profession can have sole responsibility for commissioning healthcare, and without a mix of healthcare professionals - including nurses - we believe that the new model of commissioning will fail."