Health secretary and NCB will only intervene when failure is 'significant'

Similarly, the NHS Commissioning Board will also need to “demonstrate reasonable grounds” for challenging decisions made by clinical commissioning groups at a local level.

It is making this amendment to the Health and Social Care Bill to avoid “micromanagement” by ministers and the board, the government said today in its full response to the Future Forum’s recommendations for changes to the bill.

In the document the government restates its intention to U-turn on the previous wording in the bill on the future role of the secretary of state.

The bill had proposed removing the health secretary’s duty to “provide or secure the provision of services”, which the Future Forum warned had been viewed by some as a reduction and weakening of ministerial responsibility for the NHS.

In its full response today, the government argued that it had actually been seeking to “strengthen overall ministerial accountability”, but admitted that the bill was currently “not clear enough” on this issue.

As a result it confirms that the wording of the 2006 NHS Act, which makes the health secretary responsible for promoting a comprehensive health service, would remain unchanged.

The document adds that the bill will also make clear that the Secretary of State will retain “ultimate accountability” for securing the provision of services. But it notes that rather than securing services directly, the health secretary will exercise this duty through a mandate with bodies like the NHS Commissioning Board.

The response goes on to say that the government will “make clear” that ministers will be responsible for overseeing and holding to account national bodies – in particular, the NHS Commissioning Board and the regulators – backed by “extensive powers of intervention in the event of significant failure”.

The bill currently says the health secretary will have “powers of direction over the entire system in the event of an emergency, and powers to direct national bodies if they fail to perform their functions”.

The response document states: “To avoid political micromanagement, we will amend the bill to make clear that intervention powers may only be used if the failure is ‘significant’. Similarly, the NHS Commissioning Board will need to demonstrate reasonable grounds before intervening in a commissioning group’s decisions.”

The document also reiterates a proposal in its initial response to the forum to give the health secretary “explicit powers” to report on the performance of all national NHS bodies, as part of the Department of Health’s annual report on the NHS.