The NHS Bill is a skeletal piece of legislation which conjures up the ghost of Henry Vlll in the powers it gives ministers. Lyn Whitfield reports

The launch of the government's Health Bill will not be recalled as a great parliamentary occasion.

Hansard records that its first reading took precisely one minute at the end of a Lords debate on the banana dispute between the EU and the US. A hastily arranged press conference the next morning was less than packed.

The centrepiece of the bill is the government's reform of primary care. Almost exactly 10 years after a Conservative administration issued its reform blueprint, Working for Patients, the first clause sweeps away GP fundholding in three lines, replacing it with primary care trusts. The Health Bill also drives forward the government's quality agenda by outlining a 'duty' for 'each PCT and NHS trust to put and keep in place arrangements for the purpose of monitoring and improving the quality of healthcare which it provides for individuals'.

This wording is welcomed by NHS Confederation policy adviser Tim Jones. 'The interesting thing about the duty of quality - which had concerned us because we thought chief executives could be in the dock if things went wrong - is that the duty is to get the process in place to pick up lapses and ensure improvements.

'That is one step removed from a duty to provide quality. But it is quite useful, because it makes the lines of accountability clear.'

Andrew Corbett-Nolan, development director of the Health Quality Service, says: 'I think it shows that politicians have their hearts on the left and their wallets on the right.

'As we came up to the election, they were talking about quality and now they are not talking about more than they can deliver.'

The bill also paves the way for the Commission for Health Improvement and indicates it could be given sweeping powers.

CHI will have the 'function of' providing advice and information to PCTs and trusts on meeting the new duty of quality, and carrying out reviews to see how well they are doing. It will also be able to carry out investigations into the management, availability and quality of care provided by NHS bodies.

Subject to regulation, these investigations will be backed by the power to inspect premises, inspect and take copies of documents and require 'prescribed persons' to co-operate.

Subject to regulation again, CHI will be able to publish confidential information without consent if it 'considers that there is a serious risk to the health and safety of patients' or if it feels 'the risk and urgency of the exercise' demands it. And it may be able to recover from 'prescribed persons' the cost of 'expenditure incurred by the commission in the exercise of any of its functions'.

Mr Jones summarises: 'Basically, the bill says, 'we can do anything we like, at any time we like, and charge you for it as well'.'

But while the bill gives CHI a potential armoury of weapons, it sheds little light on what sort of organisation will wield them - or whether it will do so.

Mr Corbett-Nolan says: 'In politician-speak, there is always a lot of chest beating. What is important is who the government gets to run this thing and what sort of relationships they develop.

'This is not going to be a fly-by-night organisation. They are going to be around for years, and will have to build up a relationship with the service.'

Several organisations - including the Royal College of Nursing and NHS Confederation - have raised concerns about CHIs' potential power to publish information without consent.

'There is a lot of reassuring stuff about patient confidentiality until you get to that bit, and then it is trampled on,' says Mr Jones.

The Health Bill's next section is on breaking down Berlin Walls - although it does not use health secretary Frank Dobson's pet phrase. It sets out two new duties. The first is for 'health authorities, special health authorities, PCTs and trusts to co-operate with each other in exercising their functions'.

The second is for HAs to draw up health improvement programmes and for NHS bodies and local authorities to co-operate.

The bill makes it clear that the NHS and local authorities must work together. Detailed clauses allow NHS bodies to make capital or revenue payments to local authorities. Both can 'enter into prescribed arrangements' for carrying out each other's functions 'if the arrangements are likely to lead to an improvement in the way in which those functions are exercised'.

If the bill gives CHI sweeping powers, they are nothing compared to the powers health secretaries will have to curb drug prices. While a voluntary scheme - such as the existing Pharmaceutical Price Regulation Scheme - remains in operation, they will be able to stop drug companies increasing prices, and limit prices and profits.

In addition, 'the secretary of state may, after consultation with the industry body, make any provision he considers necessary or expedient (to) introduce a statutory scheme' and set out its provisions.

And, 'any person' who contravenes the regulations will be subject to a fine -£100,000 or£10,000 a day - which may be 'increased by an amount not exceeding 50 per cent'.

Dr Kieran Walshe, senior research fellow at Birmingham University's health services management centre, describes the powers as 'Draconian'. He says: 'The secretary of state can regulate people's prices and take their profits away. And if they do not play ball, it says: 'we can bring in a statutory scheme that means everything becomes compulsory'.'

The Association of the British Pharmaceutical Industry professes not to know what the fuss is about. A spokesperson 'cannot see' why the government should need its reserve powers to bring in a statutory scheme, or why it should want to fine anyone.

Department of Health officials say the bill aims to 'provide a proper statutory underpinning' for the PPRS, and fines are needed to check 'a few' companies that are not abiding by the rules at the moment.

The bill's proposals on 'modernising' professional self-regulation have received an equally frosty response.

In essence, it says 'Her Majesty may by order in council' change the regulation of any profession currently regulated by a number of acts of Parliament. Or, 'any profession to which (these) do not apply and which appears to Her Majesty to be concerned (wholly or partly) with the physical or mental health of individuals and to require regulation.'

The first part will allow health secretaries to alter the regulation of groups such as doctors and nurses by regulation - a 'less cumbersome' procedure than debates in Parliament.

The British Medical Association says it hopes health secretaries will 'abide by the spirit' of a reassuring letter sent out by health minister John Denham amid speculation that the bill would contain just such a 'Henry VIII' clause. It promised 'real safeguards' for professional self- regulation, and the RCN says the bill appears to 'preserve' the General Medical Council and the UK Central Council for Nursing, Midwifery and Health Visiting.

On the other hand, Dr Walshe says: 'You would not be paranoid, necessarily, if you thought that this allowed for changes down the line and new registers for people like complementary practitioners.'

The 'catch-all' section does seem to be aimed at unregulated groups. But Helen Caulfield from the RCN's legal team, says it has been concerned for a long time that healthcare assistants are not regulated; 'it is not clear that this bill will allow them to be. It suggests they could be, if they are counted as a profession'.

Judging the bill's real impact, she adds, was made harder by a delay in publishing its explanatory notes. These were still with the printer, leaving experts to compare clauses in the bill with clauses in the dozens of acts it seeks to amend.

The BMA has been highly critical of the 'lack of detail'. Ms Caulfield says it is 'a skeleton bill that will be a skeleton act'. Mr Jones calls it 'sketchy'.

Dr Walshe agrees, but sees this as part of a wider trend, 'a move in government to work through statutory instruments and secondary legislation'.