The Health and Social Care Bill should become law by Easter, after the government won the final House of Commons vote on its NHS reforms last night.
Despite a last-ditch attempt by Labour to delay the vote so the risk register for the latest upheaval could be published, the government won with a majority of 88.
The bill, which will make GP-led clinical commissioning consortia responsible for two thirds of NHS commissioning, and introduce more competition for NHS providers, has been in Parliament for more than 18 months.
The reforms were originally outlined in the ‘Liberating the NHS’ white paper in June 2010.
The subsequent bill had passed all its Commons stages when growing concern from unions, professional bodies and the Liberal Democrats forced Prime Minister David Cameron to set up a ‘listening exercise’ last spring, led by the NHS Future Forum.
The revised bill returned to the House of Lords in the autumn, where it faced more than 1,000 amendments, including some important changes on confidentiality that had been demanded by doctors.
Among its many clauses, the bill establishes the NHS Information Centre as a corporate body.
It initially required all health or social care bodies to provide the NHS IC with “any information which the centre considers is necessary or expedient for the centre to have for the purposes of any function it exercises.”
The Lords inserted a line about requests for confidential information being subject to “any rule of common law which would otherwise prohibit or restrict the disclosure.”
The change is welcome news to joint chairman of the BMA and RCGP’s joint IT committee Dr Paul Cundy, who wrote an open letter outlining his concerns about this part of the new legislation last year.
Dr Cundy said the changes meant that: “What was an open ended ability to extract and disseminate information has now been drawn back to the current legal status which is the common law of privacy.”
However, unions reacted with anger and disappointment to the passage of what Unison called “this pernicious bill” as it held a vigil for “the end of the NHS as we know it” outside Parliament yesterday afternoon.
General secretary Dave Prentis warned that the vote “will not be the end of Unison’s opposition. We will campaign hard to try and mitigate the worst excesses of this bill.”
Some expert commentators have warned that the final bill is, in some ways, worse than the proposals first outlined in the white paper.
The listening exercise and amendments have added layers of complexity and central checks and balances to the original plans to streamline NHS commissioning and open up services to competition from ‘any qualified provider’.
The NHS Commissioning Board is one of a number of potentially powerful new players at a national level, while the remnants of the old strategic health authorities and primary care trusts have been left in place, and new, local, bodies such as clinical senates added to the mix.
The future arrangements for NHS IT remain unclear, with the NHS Commissioning Board advertising this week for a £165,000 national director of ‘patient insight’, a new ‘delivery agency’ to replace NHS Connecting for Health promised, and cluster PCTs and CCGs making different arrangements for IT and data support.
NHS Confederation chief executive Mike Farrar said NHS leaders would now have to “find a way through the considerable confusion and complexity that we have been handed” while “healing the rifts that have opened as many of our clinical staff have debated the merits of the bill.”
He also warned that they would have to do this while delivering on the ‘Nicholson Challenge’ to make £20 billion efficiency savings over the next three years, to bridge the gap between flat funding for the NHS and growing costs and demand.
The Financial Times reported yesterday that NHS finance director Richard Douglas has already warned senior managers that another £20 billion of savings may be needed in the five years after the present spending round finishes.