The government today published full details of the changes to its reform plans in a command paper to Parliament.

It builds on new proposals announced last week following a “listening exercise”. It sets out where changes will be made to the Health Bill.

In a statement health secretary Andrew Lansley said: “It was right that we took the time to pause, listen, reflect and improve our plans and I believe our proposals are now stronger thanks to this process.

“I have accepted the recommendations from the team of top health experts because they will improve care for patients. The last few weeks have shown broad agreement that there is an overwhelming case for a modernised NHS, and that the principles of putting patients at the centre, focusing on results and putting professionals in charge are the right ones.

“I believe the revised plans we set out today will both safeguard the future of our NHS, and ensure it is more efficient and more accountable, moving us closer to having a high-quality health service that puts patients at the heart of everything it does.”

Key changes include:

  • we’ll make clear in the Bill that Ministers are responsible for the NHS overall - the original duty to promote a comprehensive health service will remain.
  • commissioning groups will all be established by April 2013 - there will be no two-tier system. They will not be authorised to take on any part of the commissioning budget in their local area until they are ready and willing to do so. Where a group is not yet ready, the NHS Commissioning Board will commission on its behalf;
  • improve governance for clinical commissioning groups: their governing bodies will have lay members and will meet in public; GP consortia will be called “clinical commissioning groups”. They will have governing bodies with at least one nurse and one specialist doctor;
  • commissioners will be supported by clinical networks (advising on single areas of care, such as cancer) and new “clinical senates” in each area of the country (providing multiprofessional advice on local commissioning plans) - both hosted by the NHS Commissioning Board.
  • we’ll make sure the NHS Commissioning Board and clinical commissioning groups take active steps to promote the NHS Constitution, which enshrines the core principles and values of the NHS, including the 18 week limit on waiting times
  • Monitor’s core duty will be to protect and promote the interests of patients - not to promote competition as if it were an end in itself; there will be new safeguards against price competition, cherry picking and privatisation; the NHS Commissioning Board will promote innovative ways to integrate care for patients.
  • insist that foundation trusts have public board meetings;
  • there will be “clearer duties across the system to involve the public, patients and carers”
  • “there will be a careful transition process on education and training, to avoid instability - we’ll publish further proposals in the autumn”
  • ensure a safe and robust transition for the education and training system, taking action to put Health Education England in place quickly to provide national leadership and strong accountability while moving towards provider-led networks in a phased way; improve the quality of management and leadership, for example by retaining the best talent from PCTs and SHAs and through the ongoing training and development of managers.