Liberal Democrat and Conservative MPs were set to vote against the NHS Reform Bill at its second reading this week, with Labour backbenchers also unhappy with ministers' proposals for a new patient and public involvement system.
The government's second bid to abolish community health councils and replace them with a complex new system was expected to be the key battleground. MPs' ire has been stoked by ministers' refusal to incorporate patients' councils - groupings of patients' forums covering a local health economy - in its latest proposals.
The councils, proposed by Commons health select committee chair David Hinchliffe, had won cross-party support and reluctant government backing during debate over the Health and Social Care Act.
Speaking before the second reading debate, Mr Hinchliffe told HSJ that unless ministers provided the detail to allay his concerns, he would 'be making clear my view that the government has not gone far enough'. Other Labour backbenchers were also 'looking for more information', he said. 'It is all to play for at the moment.'
Liberal Democrat health spokesman Dr Evan Harris said:
'We'll be voting against the second reading.' The 'absence of anything resembling patients' councils' was 'a serious deficiency and a retraction from the undertaking people felt they had been given during the last time this legislation was discussed', he said. He also attacked the measures to put the Shifting the Balance of Power in the NHS shakeup into law. 'It is entirely the wrong approach.What the health service needs is not more change in structural terms but the breathing space to press on with the changes already in progress.'
HSJ sources indicated that the Conservatives would also oppose the bill. Its MPs were expected to criticise the Shifting the Balance reform as one that 'does not decentralise', and to maintain support for CHC campaigners.
Junior health minister Hazel Blears released the government's response to its 'listening exercise' on patient and public involvement, and an optimistically titled 'final package of measures' just days before the debate. It says the new national Commission for Patient and Public Involvement in Healthcare would set up local networks of staff, each with a 'lay reference panel' to commission independent complaints advocacy and co-ordinate patients' forums.
Primary care trust patients' forums - but not those for hospital trusts - would be given 'collectively the power to attend strategic health authority meetings'. This model 'takes and builds on the concept of patients' councils', the document says.
London Health Link chair Elizabeth Manero welcomed signs of movement by the government, and the 'huge turnaround' in approach since the wrangle over the Health and Social Care Act.
'They have been willing to talk, willing to listen and willing to change. There are some very serious concerns which we are continuing to discuss. But the climate is wholly different and I commend them for that, ' she said.
In a letter to HSJ, to be published next week, leaders of five patients' charities 'broadly welcome' the government document.
But 'proper funding' would be essential for the new system to succeed, they stress.
MPs were also expected to echo the British Medical Association's call for 'a single inspectorate' to cover both the NHS and private healthcare, made up by merging the Commission for Health Improvement - whose remit would be widened by the bill - with the National Care Standards Commission.