Prime Minister David Cameron has set out significant changes to the coalition government's controversial NHS reform plans for England, which many observers expect will be reflected in the NHS Future Forum report due to be delivered to the cabinet early next week.
In a major speech, Mr Cameron acknowledged that "many people have had concerns" about the reforms put forward by Health Secretary Andrew Lansley, and emphasised the need for "taking people with us - the public who use the NHS and the professionals who make it what it is." Which was why the government had conducted two-month listening exercise about the plans, overseen by the Forum, and as a result, he said, "a whole range of people are changing their view."
Discussing health professionals' opposition to Mr Lansley’s plans to increase competition in the NHS, Mr Cameron emphasised that competition "is a good thing" and "one way we can make things work better for patients." However, he added that the government "will not be selling-off the NHS, we will not be moving towards an insurance scheme and we will not introduce an American-style private system."
He was also anxious that the legal duty of the regulator Monitor to promote competition should not be misinterpreted. "Monitor's main duty is to protect and promote the interests or people who use health care services and it will use competition as a means to that end. It will be tasked with creating a genuine level playing field," he said, adding: "that's why we will look to make sure private companies are only paid for the services they provide and that they contribute to the costs of training NHS staff."
Monitor will also have a new duty to support integration of services - whether between primary and secondary care, mental and physical care or health and social care, he went on.
In a major change to the current proposals, the government now wants hospital doctors and nurses to be involved in clinical commissioning, and for local commissioning to go ahead only when "groups of GPs are good and ready," rather then requiring them to adhere to the originally-proposed April 2013 deadline. It also plans to introduce "clinical senates, where groups of doctors and health care professionals come together to take an overview of the integration of care across a wide area," said Mr Cameron.
"So our changes will now secure clinically-led commissioning - not just GP commissioning - and integration wherever appropriate," he said.
The Prime Minister again stressed that "we will not cut spending on the NHS - we will increase it,” but added that the demand for health care had to be reduced through the prioritization of public health, and that health care supply has to be made more efficient to deal with the pressures create by “new and expensive drugs and technologies.”
“Which is why we are opening up the system to new providers and putting clinicians in control,” he said.
The British Medical Association (BMA) which has been a severe critic of the government's reform plans, gave Mr Cameron's speech a guarded welcome, describing it as a "step in the right direction."
It was "encouraging" that many of the concerns which have been raised repeatedly by the BMA have been taken on board, said Hamish Meldrum, chairman of council at the BMA, who added that Mr Cameron's speech suggests he is committed to integrated NHS services and the involvement of a wider range of staff in their decision.
However, Dr Meldrum added that the Prime Minister had also spoken "in glowing terms about the benefits of competition, and we would point to the many damaging effects its application in the NHS has had so far."
• In Parliament, Labour leader Ed Miliband responded to the Prime Minister’s speech by declaring that he had made promises which he then broke because "he is completely shameless and he will say anything."
However much the Prime Minister says he loves the NHS, how many times he says it, "the truth is he has got the wrong values. He wanted to put a free market free for all at the centre of our service," said Mr Miiband, adding: "any changes made now are not because he wants to make them but because he has been found out."