Analysis of this week’s Health Bill by HSJ and lawyers Beachcroft has shed further light on the direction and nature of health secretary Andrew Lansley’s NHS reforms.

It will create the new NHS Commissioning Board - which the July white paper promised would be “lean and expert” - and hand it what appear to be “surprising” and “draconian” powers over commissioning consortia - including setting standards for their creation, directing them, having them taken over and abolishing them altogether. The board will be able to hire and fire their accountable officers, as well as having extensive leeway to bail them out.

In relation to commissioning consortia - which will take on responsibility for the majority of NHS services - the bill includes few requirements for how they should be run or governed. They will have none of the defined independence from the government enjoyed by foundation trusts, but there is no requirement for them to have a board, or patient representatives, for example.

The bill also adds detail to consortia relationships with council-led local health and wellbeing boards, and the makeup and power of those boards.

It further develops the government’s plans for freedoms for NHS providers and greater competition. The removal of the cap on foundation trusts’ income from private patients could leave them open to competition law challenges, according to Beachcroft, while Monitor could challenge NHS staff pension on the basis of an “unlevel” playing field between NHS and private providers. Foundation trusts will be given further freedoms, including to more easily merge with and acquire each other.

However, those concerned by the impact of the market could be assured by provisions for oversight of the “taxpayers’ investment” in foundation trusts to be retained in a banking function “established by the DH”; and for tribunals to rule on whether NHS services should be “protected” from closure. The bill sets out how providers will contribute to a fund to maintain these essential services in the event of failure.

Mr Lansley has said his reforms will limit his own power and, according to Department of Health notes accompanying the bill, they will end health secretaries’ “general power of direction” over the NHS. However, Beachcroft say health secretaries will be able to significantly shape the NHS through areas left to future regulations. They will also retain specified extensive levers including directing Monitor - and through it providers; deciding what is commissioned by the NHS Commissioning Board; and directing local authorities’ over public health.

The Department of Health’s long awaited impact assessment for the reforms - showing the estimated cost, benefit and risk - includes the admission that the transition could mean NHS staff losing focus on patients. It also reveals the reforms are expected to cost £1.2bn in the next two years; the average redundancy cost per manager is expected to be £48,000; and planned management cost cuts would be at risk if consortia are too small.