The health secretary has admitted his NHS reform bill might have to return to committee stage in the Commons – leading to warnings of further delay and uncertainty.

Asked about the prospect that changes to the Health Bill would mean it facing committee scrutiny for a second time, Andrew Lansley said: “We won’t decide that until we have received the NHS Future Forum [listening exercise] report and have responded to that.

“I told the House of Commons on 4 April that we would ensure proper scrutiny of the bill – we have done that so far and we will continue to do so.”

HSJ understands such a move could stretch the bill’s passage into the spring of 2012. Shadow health ministers were this week expected to make calls in the Commons for the bill to be sent back to the committee stage.

Senior NHS sources said it could further delay changes now currently planned for July next year. These include establishing the NHS Commissioning Board and abolishing strategic health authorities; establishing Monitor as an economic regulator and abolishing the Cooperation and Competition panel; and establishing Public Health England.

One SHA director said the continued delay risked becoming a “terminal event” for SHAs and primary care trusts as more staff decided to leave.

The source said those left were losing motivation: “Even the optimistic people who generally see the glass as half full are now beginning to think twice.”

NHS Norfolk and Great Yarmouth and Waveney cluster chief executive Andrew Morgan said: ” Further delay would [risk causing us to] lose momentum, direction and the commitment of staff who are unsure about their futures. We need to know what agenda we’re delivering and at what pace we’re delivering it.”

“We need to know what agenda we’re delivering and at what pace we’re delivering it.”

An NHS source involved in the Future Forum said it may be able to mitigate the problems by calling for quicker establishment of the NHS Commissioning Board and offering greater assurance that PCT clusters would evolve into support organisations for commissioning consortia. Both would add to commissioning staff job security.

Meanwhile, the NHS Confederation published its response to the listening exercise, calling for major changes to avoid “unintended consequences” for Monitor’s role. These included giving Monitor a duty to “protect and promote the interests of people who use healthcare services and taxpayers”, and to “promote cooperation and integration alongside competition”.

Incoming chief executive Mike Farrar called for a “speedy resolution” to the political debate. He said: “There’s a need for politicians to be mindful of the need for clarity so the service can get on and do what it does best – improving the lives of patients.”