Health Bill: Lords to debate hospital failure, integration and commissioning bonus

The Lords committee stage begins today and is expected to continue for more than a month and potentially into next year. Further amendments can be tabled throughout the process.

Ministers have suggested they will accept some changes. These are particularly likely to be to the health secretary’s duties and accountability and the foundation trust private patient income cap.

The potential for the bill to be delayed may push the government to accept some of the amendments and private negotiations are expected to take place throughout the committee sessions.

The amendments include a proposal from former health minister Lord Warner to create “pre-failure” regime, under which Monitor would be able to set up an expert panel to look at unsustainable services and order reconfiguration.

Lord Warner told HSJ he hoped it would press the government into speeding up the current process for reconfiguration – something the NHS Confederation has called for.

Another change, tabled by medic, academic and former NHS manager Baroness Murphy, would remove section 141 of the mental health act, which allows MPs to be automatically removed from Parliament if they suffer from mental ill health for more than six months. Baroness Murphy said she was hopeful it would succeed and Earl Howe, now a health minister, had supported the change in the past. The change has the support of campaigners, professional groups and many politicians.

Other amendments to the Health Bill, if passed, would:

• Change the accountability and responsibility of the health secretary and remove the “autonomy clause”, which requires the health secretary to protect autonomy;
• Strengthen requirements on organisations in the new system to reduce health inequalities;
• Mean that the quality premium commissioning bonus can only be spent “to improve outcomes”, rather than becoming GP income;
• Force the government to respond to the Dilnot review social care recommendations;
• Require Monitor to produce tariffs which encourage integrated services;
• Allow clinical commissioning groups to pass parts of their duties and budget to council health and wellbeing boards;
• Require the government to publish – and CCGs to follow – further governance requirements, particularly on dealing with conflicts of interest;
• Give the NHS Commissioning Board a means to challenge the health secretary if it believes he or she is not giving the NHS enough money in the mandate, through a public letter.