Clinicians' leaders have welcomed the government's acceptance of the NHS Future Forum's key recommendations for changes to its planned Service reforms, but independent providers are disappointed at the "overall dilution" of the role of economic regulator Monitor.
The fundamentals of the government's plans for the NHS are "as strong today as they have ever been, but the detail of how we are going to make this all work has really changed as a direct result of this consultation," said Prime Minister David Cameron, discussing the government's proposals this week. "We have listened, we have learned, and we are improving our plans for the NHS," he added.
Among the key changes announced by Ministers are: - wider involvement by experts in clinical commissioning groups (as the commissioning consortia will now be known), including nurses and specialists; - stronger safeguards against a "market free-for-all," with Monitor's core duty being to protect and promote patient interests rather than requiring it "to promote competition as if it were an end in itself;" and - additional safeguards against privatisation, with the creation of a "genuine level playing field" to stop private companies cherry-picking profitable NHS business - "we will ensure that competition is on quality, not price," says the government.
Other major changes will be: - greater information and choice for patients; - allowing clinical commissioning groups to take charge of commissioning when they are ready and able, and a more phased approach to the introduction of Any Qualified Provider; - a new duty for the groups to promote joined-up services both within the NHS and between health, social care and other local services; and - all providers to make "a fair contribution" to the costs of education and training of NHS staff.
Ministers have also pledged to take further steps to embed the NHS Constitution into the way the Service works, and, where necessary, to adapt how the patient rights contained within the Constitution are given legal force. "This includes the right to drugs and treatments recommended by the National Institute for Health and Clinical Excellence [NICE], which we will retain after the introduction of value-based pricing for new drugs from January 2014," says the government.
Clinicians' leaders have welcomed the changes, particularly those relating to Monitor. The British Medical Association (BMA), which had previously warned that the regulator's planned role of encouraging competition would be "highly damaging," said the shift away from this was welcome.
"However, while we have always supported the principle of greater choice for patients, it has to be workable. There will need to be robust safeguards to ensure that vital services are not destabilised by unnecessary competition," added Hamish Meldrum, chairman of council at the BMA.
Royal College of General Practitioners (RCGP) chair Clare Gerada said the College is pleased that the Prime Minister now seems to be addressing the concerns that it has been raising since the outset; these are competition, choice and the role of the private sector, ensuring that the Secretary of State remains accountable for the NHS and "how we deliver improved and joined-up care for our patients as a result of the reforms."
Sir Richard Thompson, president of the Royal College of Physicians (RSP), was particularly happy with the commitment that hospital doctors will be on the boards of local commissioning groups. "The renaming of 'commissioning consortia' to 'clinical commissioning groups' will reflect the collaboration from a wide range of experts to commission the best services for patients," he added.
However, the NHS Partners Network, which represents independent health care providers, said the process of reforming the provider side of the NHS to better meet patients' needs has now been "set back by several years."
"Providers who have worked immensely hard to integrate with and support the NHS are disappointed at the government's failure to recognise this or provide wholehearted commitment to the independent sector for the future," said Network director David Worskitt.
The Network (which is part of the NHS Confederation) welcomed the decision to retain Monitor's Cooperation and Competition Panel, but not the "overall dilution" of the regulator's role and the return to more centralised control and direction via the National Commissioning Board. "The commitment to patient choice rings hollow when there is so little real encouragement of diversity or providers to make it meaningful," said Mr Worskitt.
"The independent sector continues to believe that the NHS needs more innovation, diversity and robust, fair competition if it is to meet the challenges it faces," he added.
Chris Ham, chief executive of the health policy think tank The King's Fund, particularly welcomed the emphasis on clinical commissioning, a "more nuanced approach" to competition and an evolutionary approach to implementing the reforms, but he also warned that: "the sheer number of changes being made to the structure of the health system risks creating confusion and additional bureaucracy. The government will need to specify very clearly how these bodies will operate and work together."
And NHS Confederation chief executive Mike Farrar emphasised the need to make sure the new system is not over-centralising and that there is "real momentum towards the important goal of pushing power down to the local level." This will require getting the new clinical commissioning consortia in place as soon as possible, said Mr Farrar, adding: "we have to stress-test all the changes the government is making to make sure they are workable and deliverable."
• Following the government's acceptance of the NHS Future Forum's key recommendations, it will shortly set out the amendments to be made to the Health and Social Care Bill, plus details of the relevant parts of the legislation which will now be recommitted to Parliament. The government has also announced that the Forum will continue to lead on listening in the NHS, focusing on topics including education and training, patients' rights and public health.