The government should change and clarify the Health Bill to help the NHS deal with its enormous financial pressures, the NHS Confederation has said.

The Confederation published a briefing for peers on Monday ahead of the bill’s second reading today.

It says the proposed new NHS structure “is much more complex than the present system” which poses a “danger the NHS could find itself in paralysis at just the moment it needs to make key decisions that are crucial for the sustainability of parts of the NHS”.

Confederation chief executive Mike Farrar called on Lords to examine – in addition to points of principle – how the bill would be implemented, and affect attempts to improve efficiency and quality.

He told HSJ: “We need to go one step below the principles and look at the operationalisation, and see if that makes sense. Will [the changes] stack up and be able to be delivered?”

An example, he said, was to ask how potential clashes between different organisations – such as Monitor and the NHS commissioning board – would be resolved.

Mr Farrar said, while the NHS Commissioning Board was answerable to the health secretary through its annually updated “mandate”, it was unclear how others such as Monitor, Public Health England, and the Care Quality Commission were answerable.

In relation to competition he said neither universally applying competition nor ruling it out altogether were right so, “we need an intelligent regulation system which will handle that”.

Mr Farrar said the application of any qualified provider rules was a test of giving commissioners the “right to make local decisions” about competition and integration. The government has required every PCT cluster area to apply the mechanism to a number of services from next year.

The Confederation is calling for the bill is being changed to:

  • confirm clinical senates will not have a veto over clinical commissioning groups’ plans, and commit to designing detailed remits and powers for all actors in the system to minimise confusion.
  • agree new standards for reconfiguration, to enable quick and locally led decisions, and limiting the ability of council overview and scrutiny committees to refer them.
  • impose a duty on the NHS Commissioning Board to build and support CCG competence and capability, and ministerial commitment to monitoring how quickly the board delegates to local groups.
  • commit ministers to further developing the quality and financial failure regimes, with the aim of allowing emerging problems to be identified early, and supporting organisations which are in danger of failing, with the aim of preventing the need for formal intervention.
  • properly resource commissioning and management, urgently clarify the running costs of clinical commissioning groups, and publicly champion the value of good management.
  • commit that commissioners will not be subject to overly detailed, prescriptive guidance from Monitor. Monitor should oversee a national framework for local use in supporting decision making around when competition, integration and choice will be most effective, and able to take action if providers or commissioners operate outside it.