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Rethink NHS overhaul, review says Rethink NHS overhaul, review says
(40 minutes later)
By Nick Triggle Health correspondent, BBC NewsBy Nick Triggle Health correspondent, BBC News
The health plans for England need a major re-write to ensure the best interests of patients are protected, an independent review says.The health plans for England need a major re-write to ensure the best interests of patients are protected, an independent review says.
The NHS Future Forum, which carried out a two-month consultation, called for the overhaul to happen more gradually.The NHS Future Forum, which carried out a two-month consultation, called for the overhaul to happen more gradually.
The panel of experts also said it wanted to see a greater balance between competition and co-operation among NHS hospitals, charities and private firms.The panel of experts also said it wanted to see a greater balance between competition and co-operation among NHS hospitals, charities and private firms.
Ministers are expected to respond to the recommendations on Tuesday.Ministers are expected to respond to the recommendations on Tuesday.
They hope that by acting quickly they will be able to get their NHS reform programme back on track in weeks.They hope that by acting quickly they will be able to get their NHS reform programme back on track in weeks.
In April the government took the unprecedented move of halting the parliamentary progress of the Health and Social Care Bill underpinning the changes amid mounting criticism from academics, health unions and MPs.In April the government took the unprecedented move of halting the parliamentary progress of the Health and Social Care Bill underpinning the changes amid mounting criticism from academics, health unions and MPs.
GP powerGP power
Ministers had originally wanted to hand GPs control of much of the NHS budget, while opening up the health service to greater competition.Ministers had originally wanted to hand GPs control of much of the NHS budget, while opening up the health service to greater competition.
But while GPs will remain in the driving seat, they should consult with other professionals, the forum said.But while GPs will remain in the driving seat, they should consult with other professionals, the forum said.
To ensure this happens, clinical senates made up of a variety of different experts including hospital doctors and nurses should be created to oversee the new system, the forum's report said.To ensure this happens, clinical senates made up of a variety of different experts including hospital doctors and nurses should be created to oversee the new system, the forum's report said.
The focus on competition - perhaps the most controversial element on the plans - also needed to be "significantly diluted", according to the forum.The focus on competition - perhaps the most controversial element on the plans - also needed to be "significantly diluted", according to the forum.
Originally, the regulator was to have a primary duty to promote competition, but that should be dropped along with the term "economic regulator", which the forum said made the NHS sound to much like the gas or electricity industry.Originally, the regulator was to have a primary duty to promote competition, but that should be dropped along with the term "economic regulator", which the forum said made the NHS sound to much like the gas or electricity industry.
Instead, the regulator should focus on ensuring patients have choice to drive up standards. While competition has a role to play in this so does collaboration and integration, the forum said.Instead, the regulator should focus on ensuring patients have choice to drive up standards. While competition has a role to play in this so does collaboration and integration, the forum said.
The report also said consortia should only take on their responsibilities when they were ready.The report also said consortia should only take on their responsibilities when they were ready.
Originally a deadline of 2013 was set, but the panel said the national board could step in in those areas that were struggling.Originally a deadline of 2013 was set, but the panel said the national board could step in in those areas that were struggling.
Professor Steve Field, the former head of the Royal College of GPs who led the forum, said while the principle of putting doctors in charge was well supported, he had heard "genuine and deep seated concerns" from many. Patients should also to be given a new "right to challenge" to put pressure on the NHS to keep standards up - although how this will work in practice was not set out in detail.
Were the original plans for the NHS in England evolution or revolution? Do the changes proposed by the independent review represent a tinkering around the edges or wholesale changes? Professor Steve Field, the former head of the Royal College of GPs who led the forum, said while the principle of putting doctors in charge was well supported, he had heard "genuine and deep-seated concerns" from many.
For both these questions you get different answers depending on who you ask. In all probability only time will tell. Accepting the recommendations in full would not represent a major climbdown for the government.
Take the issue of competition, much will rest on how the regulator interprets the legislation. Even on the most controversial element - competition - the NHS Future Forum was clear. It has an important role to play.
The response of GPs who will be driving the new NHS will also be key. Instead, many of the proposals are about moderating language.
Pilots are already up-and-running, but it is possible that the review that has taken place could take the wind out of their sails. The term economic regulator should be dropped because it makes the NHS sound like a utility industry not because it is fundamentally wrong, according to the forum.
When Labour launched its foundation trust policy to create elite hospitals free from political control it was a controversial and, it seemed, radical move. There are extra safeguards being proposed as well to ensure the policy does not lead to unintended consequences.
Seven years on, most agree they have not really lived up to the original expectations. As always, the scale of change will depend on the actions of people - in this case the doctors, nurses and managers on the front-line. But the general direction of travel remains the same. That is to say, doctors are to be given more of a say in decision-making and the private sector is to get greater involvement.
That does not mean that this review - and any government response to it on Tuesday - represents simple tinkering.
As the review team made clear there were "genuine and deep-seated" concerns.
Greater clarity was needed and in giving this, as one member of the review team has been saying, some of the rough edges will hopefully be smoothed away.
"If the substantial changes we propose are accepted by government then I think the resulting framework will place the NHS in a strong position.""If the substantial changes we propose are accepted by government then I think the resulting framework will place the NHS in a strong position."
The recommendations have been welcomed by many involved in the health service.The recommendations have been welcomed by many involved in the health service.
Sir Richard Thompson, president of the Royal College of Physicians, said the changes to competition were a "step in the right direction".Sir Richard Thompson, president of the Royal College of Physicians, said the changes to competition were a "step in the right direction".
Dr Hamish Meldrum, chairman of British Medical Association, said the government's approach during the listening exercise had been "refreshing", but this needed to be maintained in the coming months.Dr Hamish Meldrum, chairman of British Medical Association, said the government's approach during the listening exercise had been "refreshing", but this needed to be maintained in the coming months.
"Obviously, the critical factor is now how the government responds.""Obviously, the critical factor is now how the government responds."
Professor Chris Ham, chief executive of the King's Fund think tank, agreed.Professor Chris Ham, chief executive of the King's Fund think tank, agreed.
"The government must now move quickly to endorse today's report, put an end to the disagreements that have dominated recent months and provide the direction and stability the NHS desperately needs to navigate the challenging times ahead.""The government must now move quickly to endorse today's report, put an end to the disagreements that have dominated recent months and provide the direction and stability the NHS desperately needs to navigate the challenging times ahead."
But Dave Prentis, general secretary of Unison, did express concerns.But Dave Prentis, general secretary of Unison, did express concerns.
He said: "The forum's changes may airbrush some of the flaws, but no amount of fiddling around around the edges is good enough when the future of the NHS is at stake."He said: "The forum's changes may airbrush some of the flaws, but no amount of fiddling around around the edges is good enough when the future of the NHS is at stake."
Government moodGovernment mood
Despite the formal announcement by government not being made until Tuesday, Prime Minister David Cameron has already accepted concessions will be made.Despite the formal announcement by government not being made until Tuesday, Prime Minister David Cameron has already accepted concessions will be made.
Last week he set out a series of areas he was planning to give way on. These chime closely with what the forum has now proposed.Last week he set out a series of areas he was planning to give way on. These chime closely with what the forum has now proposed.
Speaking ahead of the full government response, Health Secretary Andrew Lansley said the group had been an "invaluable source of expert advice".Speaking ahead of the full government response, Health Secretary Andrew Lansley said the group had been an "invaluable source of expert advice".
The political fall-out within the coalition is also being closely scrutinised.The political fall-out within the coalition is also being closely scrutinised.
On Monday Deputy Prime Minister Nick Clegg is expected to claim the Lib Dems have got their way in coalition battles over the bill when he meets his parliamentary party.On Monday Deputy Prime Minister Nick Clegg is expected to claim the Lib Dems have got their way in coalition battles over the bill when he meets his parliamentary party.
But backbench Tories have being vocal in expressing concerns the reforms are being watered down too much.But backbench Tories have being vocal in expressing concerns the reforms are being watered down too much.
Labour has indicated it will be voting against the bill whatever the changes are.Labour has indicated it will be voting against the bill whatever the changes are.
Shadow health secretary John Healey said: "My fear is that we'll hear the prime minister claim these are substantial and significant changes, but the long-term ideological plan to turn the NHS into a market, to open up all parts of the NHS to private companies, will remain."Shadow health secretary John Healey said: "My fear is that we'll hear the prime minister claim these are substantial and significant changes, but the long-term ideological plan to turn the NHS into a market, to open up all parts of the NHS to private companies, will remain."
Nonetheless, the BBC understands that ministers are hopeful the NHS Future Forum report and the government response will allow them to press ahead almost immediately with the programme.Nonetheless, the BBC understands that ministers are hopeful the NHS Future Forum report and the government response will allow them to press ahead almost immediately with the programme.
Officials are working on the basis that amendments could be made to the bill within weeks, allowing the government to kick-start the parliamentary process before the summerOfficials are working on the basis that amendments could be made to the bill within weeks, allowing the government to kick-start the parliamentary process before the summer
Do you work in the NHS? What is your reaction to the government's planned reforms? You can send us your views using the form below.Do you work in the NHS? What is your reaction to the government's planned reforms? You can send us your views using the form below.