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Health bill may have to be withdrawn - doctors Further 'delay' over NHS changes
(about 7 hours later)
By Nick Triggle Health correspondent, BBC NewsBy Nick Triggle Health correspondent, BBC News
The government's health plans for the NHS in England need changing so much that the entire bill may need to be withdrawn, doctors say. The Deputy Prime Minister has suggested further delaying plans to change the way the NHS in England is run.
The British Medical Association called for a series of changes as part of its submission to the listening exercise. In a speech in London, Nick Clegg said he wanted MPs to be given another chance to scrutinise the health bill once concessions are made next month.
In particular, the union has demanded the duty on the regulator to promote competition be dropped, something other critics have called for. Mr Clegg also gave a strong signal of what those steps may be including less of an emphasis on competition and a more relaxed approach to the timetable.
Nick Clegg and Labour's John Healey are to make speeches about the plans later. Earlier the British Medical Association called for the bill to be withdrawn.
The deputy prime minister's speech is keenly anticipated because he has been outspoken about the need to make significant changes to the proposals in recent weeks. The NHS reforms have been on hold for the past six weeks while the government carries out a listening exercise.
'Dog-eat-dog' But with that coming to an end, the deputy prime minister set out the direction the government was heading to an audience of health staff and campaigners.
The Lib Dem leader is expected to say that change is needed and he is determined to see the "right reform" introduced. Competition
He will point out that while the NHS has always benefited from a mix of providers, including the private sector and charities, he will not allow the NHS to be "flogged off to the highest bidder". Mr Clegg said competition would still have a role to play, but said the primary duty of the regulator would be to protect patients and promote collaboration.
"People want choice - over their GP, where to give birth, which hospital to use," he will say. "But providing that choice isn't the same as allowing private companies to cherry-pick NHS services. He added in areas where competition would be beneficial to patients it would be done in a managed way.
"It's not the same as turning this treasured public service into a competition-driven, dog-eat-dog market." He also said the duty on the health secretary to provide a comprehensive health service would be retained.
Mr Healey, the shadow health secretary, is expected to say that the government has mishandled the NHS in its first year in power, reflecting badly on the prime minister himself. What is more, the big bang approach looks like it will be relaxed. GPs were due to take charge of budgets by 2013 under the original plans, but Mr Clegg said NHS managers would be retained to support them in areas where they were not ready.
He will say: "David Cameron is a PR man looking for a PR answer." Mr Clegg said it was important to introduce the changes in a "planned and phased way".
Upheaval "We are going to tread carefully, but we are not going to shrink from what needs to be done," he added.
The attacks come as the government's listening exercise is drawing to a close. This week marks the end of the six-week process, which was launched last month as the government deferred its plans amid mounting criticisms. He conceded changes on this scale would require the bill to be sent back to repeat its committee stage - effectively putting the parliamentary process into reverse.
During the process - effectively a second consultation after one last autumn - more than 200 events have been held, with ministers promising to use the suggestions put forward to improve the bill. "I don't think it would have been right for us to have held this listening exercise, to make big changes to this legislation and then seek to bounce it through.
But the BMA's intervention illustrates just how tricky getting consensus is going to be. "I think it is very important that MPs who are accountable to millions of patients up and down the country have the opportunity to really look at the details that we are proposing and that's why I think we will need to send the bill back to committee.
As well as calling for the duty to promote competition to be dropped, the union said timetables needed to be relaxed and duties placed on GP consortia to involve other clinical staff. The BMA had put pressure on ministers to take the drastic step of withdrawing the bill in its submission to the listening exercise which it published on Thursday.
There should also be much more stress on collaboration and integration, the BMA added. The doctors' union had called for a wide range of concessions, some of which Mr Clegg mentioned.
BMA chairman Dr Hamish Meldrum said: "While change is necessary, this major upheaval is not." BMA chairman Dr Hamish Meldrum had argued while change was necessary "major upheaval" in the way being proposed was not.
But the government has received more backing from a number of other groups, including Reform, a pro-market think tank, and the NHS Confederation, which represents managers. Meanwhile, shadow health secretary John Healey said there was a risk the concessions when finally unveiled will amount to a "political fix" that would not be in the best interests of the health service.
Both argued to varying degrees in their submissions that greater competition was needed to improve care. He also said the pause reflected badly on David Cameron himself.
But the NHS Confederation said the case for the breadth of the reforms "had yet to be clearly made", while the changes were not "sufficiently focused" on the problems facing the NHS, such as the financial squeeze and variation in standards. "Whatever he decides to do with his NHS plans, this first year has raised serious questions about the prime minister and his government's judgement, competence, values and integrity."
A Department of Health spokeswoman said ministers had made it clear "substantive changes" would be made.
"The listening exercise is a genuine opportunity to improve our plans, and we look forward to hearing views from all who want to safeguard our NHS for the future."