A senior government figure has told HSJ that Monitor’s duty to promote competition and the accountability of GP consortia are being scrutinised in discussions over bill amendments.
The comments come amid growing speculation that ministers are planning to amend or water down their NHS reform plans, under mounting political pressure and criticism from health policy experts and professional bodies.
Talks on changes to the Health and Social Care Bill were at a “sensitive stage”, according to the source, who cautioned against making assumptions about what alterations were being considered.
The source told HSJ: “It’s at a sensitive stage at the moment – I can’t reveal where we’ve got to in terms of specific amendments or changes of approach.
“But don’t jump to conclusions about what emerges from this – don’t make assumptions about either the limitations of the changes, or the extent of them.”
They added: “The other area, which has been raised by people in the NHS and MPs, is the transition and the financial risk involved in that period, and whether you need to make it an evolutionary approach rather than a revolutionary approach.”
Leading Liberal Democrats are moving to put pressure on the Department of Health and coalition leadership in the hope that concessions will be made during the Easter parliamentary recess.
A well placed Lib Dem parliamentary source said there was a “strong feeling that consortia should function as proper public bodies with all the governance you would expect from that”.
The source said “people feel that the accountability of consortia is weak” and could still be enhanced through strengthened health and wellbeing boards or council scrutiny committees.
Although the Lib Dems had proposed elected commissioning boards in their 2010 election manifesto, some party members now “wouldn’t go the gallows on that”.
“It’s more important that there would be proper accountability to elected representatives, rather than elected representatives doing the commissioning.”
The Lib Dem source added that many in the party were concerned Monitor was being given a mandate to promote competition but no clear duty to encourage collaboration or service integration, and that the fixed timetable for reform could stretch capacity in some areas.
They added: “There may be ways involving a more mixed system, with stripped-down primary care trusts in some areas.”