NHS reform row 'not over', warn healthcare leaders

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The high profile row over the government’s NHS reforms will persist despite its Health Bill finally becoming law, healthcare leaders predict.

The bill received its final reading in the Lords on Monday. Following more than a year of intense debate and attempts to defeat it, it was due to be voted through by the Commons on Tuesday, and to formally complete the legislative process by gaining royal assent in the coming weeks.

The government is likely to want to move away from discussing the structural reforms and health secretary Andrew Lansley is expected to focus publicly on separate issues, for example the development of an alcohol abuse strategy.

However, senior healthcare figures told HSJ the row over the NHS changes would continue. A stream of regulations and guidance still need to be published to implement the bill.

See diagrams of the current NHS and proposed Health Bill systems - attached right

This includes details of the licensing and failure regimes for providers and the authorisation and performance management of clinical commissioning groups by the NHS Commissioning Board. A Department of Health source said it was expected that much of the detail would be uncontroversial, but some – particularly in relation to Monitor’s competition regulation – would spark further debate.

NHS Confederation chief executive Mike Farrar said: “There will [still] be a big debate going forward. The politics [about the bill] will mean everything we do for the next three years will be scrutinised incredibly heavily.”

Mr Farrar is calling for the post-bill guidance to simplify implementation and aid service redesign, which he said could be hampered by the bill. He said CCGs should have the “ability to act and freedom to be bold” and Monitor’s guidance and payment rules should encourage providers to work together.

King’s Fund chief executive Chris Ham said: “Some people might breathe a sigh of relief, or anger, that the bill is finished, but that is far from the case.”

He added funding, hospital waits and the commissioning reorganisation would be major challenges. Professor Ham predicted an “extended period of transition”, with the commissioning board acting for the large numbers of CCGs which would not be ready by April next year to take over responsibility for commissioning.

Royal College of GPs chair Clare Gerada, who opposed the reforms, said she would now focus on “the cuts” and GP-led integrated services.

“There are serious [financial] pressures. The government needs to be clear how we manage to maintain good patient care,” she added.