Government 'prepared to make major changes to NHS reforms'

The NHS is under going a major revamp

The government is willing to make major changes to its overhaul of the NHS in England, ministers say.

Amid mounting criticism, the government announced on Monday it wanted to use a pause in the parliamentary timetable to engage with people about the changes.

Deputy Prime Minister Nick Clegg said the two-month exercise was not just about presentation and could instead lead to "substantive" alterations.

However, a complete U-turn is being ruled out, the BBC understands.

The plans involve handing control of much of the NHS budget to GPs as well as opening up the health service to greater competition from the private sector.

The government has accepted there are serious concerns about some of the reforms - and wants to try to allay those by amending the bill which is currently going through parliament.

But ministers - particularly at the Department of Health - still believe some of the changes are being misunderstood.

During the next few months - before the bill returns to parliament in late Spring and early Summer - they will seek to convince people that the reforms do not amount to the privitisation of the health service that some have claimed.

In particular, they will stress that the April 2013 deadline is not an absolute cut-off.

Instead, the national board, which will be headed by NHS chief executive Sir David Nicholson, will have powers to take control of local services where GP consortia are judged to be not up to scratch.

'Listening exercise'

The full details of the "listening exercise" has yet to be fully outlined.

At first it was thought likely Mr Clegg and David Cameron would front the campaign, but there is sensitivities in the heart of government about whether that would be seen as sidelining Health Secretary Andrew Lansley.

But speaking to the BBC, Mr Clegg said the government was serious about listening to the concerns.

"It is not just a question of presentation. This is also a question of making substantive changes to the legislation at the end of this two-month process," he said.

He said changes would be made to the governance of GP consortia and to ensure that private companies do not 'cherry pick' the most profitable parts of the NHS.

"I absolutely don't want any scheme which could lead to the privatisation of the NHS.

"We're not going to flog off bits of the NHS to the highest bidder and we don't want the private sector simply to cherry pick the easy bits, undermining the integrity of the NHS."

One option being seriously considered is the idea of inviting other experts to get involved in the consortia.

This has been proposed by House of Commons' health committee.

The cross-party group of MPs said involving the likes of hospital doctors, public health chiefs and councillors would improve accountability and decision-making.

Committee chairman Stephen Dorrell, a Tory MP and former health secretary, said such a move was not just a "minor tweak", adding the knowledge of other professionals was essential to ensure the best decisions were taken and to avoid conflicts of interest.

"If you are going to design cancer services is it not a good idea to include cancer specialists?"

But he added the move would also help build consensus over the tough actions that would be needed to help the NHS save money in the coming years.

"An old rule of human nature is if you feel you are being involved you are more likely to accept consequences of a decision."

'Deep breath' advice

The committee also said the plan to encourage greater competition - a key plank of the reform programme - risked undermining the decision-making process.

The MPs said there may be instances where commissioners may want to just use one provider - perhaps a local NHS hospital to keep an A&E unit viable - but that may not be possible if competition law was strictly applied.

Rosie Cooper, a Labour member of the committee, said it was time for the government to "take a deep breath" and have a re-think over its plans.

Nigel Edwards, acting head of the NHS Confederation, which represents managers, said the proposals had merit, but he warned against getting councillors involved in the commissioning groups.

"There are very few questions to which the answer is 'more politicians'. We're all for more scrutiny of GP consortia decisions but there is a point where political involvement becomes unhelpful to the running of an organisation."