THIS WEEK

A second-term Labour government would introduce legislation early in the parliamentary term to axe community health councils, HSJ has learned.

Although the statutory existence of CHCs remains, due to the government dropping the abolition clauses to ensure the swift passage of the Health and Social Care Bill before Parliament rose for the election, it seems their stay of execution will be short-lived.

There are warnings that this time the government will be less susceptible to granting concessions: 'CHCs will certainly be replaced. . . What you get at the end of a parliament is very different to what you get at the beginning, ' a source said.

Patient representation is not mentioned in the party manifesto published last week, though the brief pledge to 'reform the clinical negligence system' is also likely to see the introduction ofearly legislation.

A green or white paper outlining ways of cutting the cost of clinical negligence to the NHS may feature a system of tariffs, where set amounts can be awarded for particular circumstances.

Party sources have said the idea of an 'off-the-shelf no-fault scheme' is not on the cards but Labour is understood to be looking at ways to ensure the NHS is not seen to be 'paying out twice' to claimants - having to pay lump sum awards for the cost of future care and then providing it.

If, as it expects, Labour secures a second victory, HSJ understands it will reject the idea that the private sector could play a significant role in running failing trusts and would look instead to back talented and successful NHS managers and to improve the service.

A scenario favoured by Labour policy-makers is the development of management 'flying squads', to oversee problem services.

'It is not about a district general hospital taking over responsibility for another DGH 100 miles away, ' one insider told HSJ. 'There are methods of allocating management talent where It is not just about individuals moving jobs but having more structural opportunities. '

The source claimed that, while private sector providers may manage more 'planned services' in diagnostics and elective surgery, they do not have the expertise to run large-scale or complex services, or to take over failing services.

Nigel Edwards, policy director at the NHS Confederation, said the private sector could bring a 'great deal of expertise to management of ambulatory care and diagnostic centres but would not have the skills or the desire to go beyond that'.

Mr Edwards also warned that a system where private sector managers were accountable clinically and financially could be 'very confusing' if - as Labour promises - they will not be responsible for managing the staff.

King's Fund health systems programme director John Appleby said fears that the private sector could take over huge parts of the NHS following Labour's concordat last year had been exaggerated.

'The private sector is relatively small in this country, ' he said, 'I think Labour have taken a pragmatic approach. Where the Department of Health can see a good deal, the price is right and resources are not being diverted from the NHS, then there is a role for the private sector. '