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Government to amend NHS reforms as pressure on Lansley grows

By Ian Quinn

Exclusive: The Government has revealed it plans to table a series of amendments to the health bill in the House of Lords, amid growing calls for a rethink from both within and outside the coalition.

The amendments will clarify plans for the role of private providers, include new details on NHS pricing and add additional rules on the transparency and accountability of GP commissioning groups.

Pulse also understands that the Government is considering a possible stay of execution for some PCT clusters beyond April 2013 – although this will not be directly addressed in the legislation.

The amendments to the bill are intended to stave off rebellion among disaffected Liberal Democrats, but Government sources stressed that this did not amount to a fundamental change in direction.

Pressure on health secretary Andrew Lansley grew this week, as the Liberal Democrats confirmed top level discussions were taking place between Deputy Prime Minister Nick Clegg and Prime Minister David Cameron about the party’s fears over the reforms.

As the bill passed its last day in the House of Commons committee stage today, Labour shadow ministers also went on the attack to claim they would work together with the Liberal Democrats in the Lords, where the bill goes next, to force changes to the plans, accusing Mr Lansley and his ministers of ignoring opposition.

A senior source in Mr Lansley’s team said the Government planned to table amendments in the Lords which would write in legislation to prevent private firms being able to ‘cherry pick’ profitable services in the opening up of the NHS market.

Other planned amendments concern ‘transparency and accountability’ for consortia, another issue high on the list raised by the Liberal Democrats.

The source told Pulse: ‘There will be some amendments. But the principles remain the same, as does the clear direction set out by the reforms.’

‘We intend to table amendments which will place a duty on the NHS Commissioning Board and economic regulator Monitor to develop a comprehensive system of pricing to ensure price reflects complexity of treatment. There is no such duty at present.’

However, the source said: ‘What isn’t going to happen is some sort of rowing back. There are not going to be major changes to the reforms.

‘The horse has already bolted on that one. We’ve already got more than two thirds of the country covered by pathfinders. We’re beyond the tipping point.’

At a press conference earlier today, shadow health secretary John Healey said Labour had met with Liberal Democrat peers who he claimed were determined to stop key elements of the bill, claiming there was a ‘growing crisis of confidence’ over the plans.

‘To date Andrew Lansley has shown no sign of listening and it’s one of the reasons why groups like the BMA are so concerned,’ he said.

A spokesperson for the Liberal Democrats confirmed there were ‘discussions ongoing’ involving party leaders and the Prime Minister, with concerns over the bill having been ‘kicked up the chain of command’.

‘They are looking at how the concerns raised can be dealt with. They will be the ultimate people who will make the decisions,’ he said.

However, the senior DH source said there was ‘nothing in the Lib Dem motion’ passed at its recent spring conference that ‘undermines the essence of the bill’.

Dr James Kingsland, special adviser on commissioning at the Department of Health, confirmed it was looking at alterations which ‘might change slightly the direction of travel that is set’, with ministers planning to ‘tighten up’ the legislation to focus price mechanisms around quality of delivery.

But he said Government advisers were calling for more communication with GPs on the ground, rather than for much tinkering with the bill itself.

Dr Paul Charlson, chair of the Conservative Medical Society, agreed that the Government would look to produce a string of more detailed guidelines for GP commissioning, adding: ‘I don’t think there will be major changes to the legislation but I’ve said to the front bench that there needs to be more articulation of the policies and what they mean on the ground. I think this will be done through guidance though, not legislation.’

Dr Charlson said the Governmment was also prepared to look again at the timing of the changes to allow certain PCT clusters to stay in operation post-April 2013.

‘There would have to be justification for that and I don’t think it will be a common occurrence but I think some clusters of PCTs may in some circumstances linger longer,’ he said.

Andrew Lansley: planning to amend health bill in the House of Lords Andrew Lansley: planning to amend health bill in the House of Lords