The government is resisting attempts to scrap the Health Bill’s so called “autonomy clause”, but close to offering a compromise amendment on the duties of the health secretary, HSJ understands.

Ministers are expected to reject attempts by Labour peers and Liberal Democrat Baroness Shirley Williams to scrap clause 4 – the health secretary’s “duty as to promoting autonomy”.

Peers interested in the issue have taken part in discussions with health minister Earl Howe in recent days.  It is understood the need to change clause 4 has been strongly disputed by the government.

Baroness Williams and Labour peers have also tabled amendments which would strengthen the health secretary’s duty to provide services – changing it to closely match previous NHS legislation. It is thought likely the government will oppose these.

However, HSJ understands ministers see an amendment tabled by Conservative peer Lord Mackay as a potential compromise.

Lord Mackay’s amendment would set out that the health secretary “retains ultimate responsibility to parliament for the provision of the health service in England”. It also says he “must exercise the intervention and other functions of the secretary of state in relation to that health service so as to secure that services are provided in accordance with this act”.

DH sources said the government was unlikely to return to the position in previous legislation but was open to changes in relation to responsibility and accountability. It has been one of the major disputed areas in recent months.

Labour frontbench peers are unlikely to accept that Lord Mackay’s amendment, or a change with similar implications, is sufficient on its own.

Ministers are expected to write to peers in coming days, ahead of the beginning of the Lords committee on the bill on Tuesday, to detail its position on issues they have raised. It will be seen as the government’s latest negotiating position.

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