Cameron outlines changes to NHS reforms after criticism

David Cameron has outlined "real changes" to controversial plans for NHS reforms in England, following criticism from health service professionals.

Hospital doctors and nurses will be involved in care commissioning, as well as GPs, regulators will have a duty to "support integration" of services and there will be limits on competition.

It comes ahead of the outcome of a consultation exercise due next week.

Labour say the plans are "botched" and would divert money from patient care.

In a speech, Mr Cameron said the government had listened to concerns about the planned reforms - which would give GPs more commissioning powers, increase competition in the NHS and abolish primary care trusts - expressed during a recent "listening exercise".

'Listened and engaged'

As a result, he said he would support a number of important changes to the proposals:

• Doctors and nurses will be involved in new consortia planning and buying care, not just GPs

• These groups will only take responsibility when they are ready not by April 2013 as previously envisaged

• New "clinical senates" consisting of senior medical professionals will oversee integration of NHS services across local areas

• NHS economic watchdog, Monitor, will have a duty to promote integration of care across an area

• Greater competition will only be introduced when it benefits patient care and choice

The prime minister also confirmed that the coalition will retain existing targets such as the 18-week limit on waiting lists in England and the four-hour waiting limit in A&E but there will be increased focus on the outcomes of treatment - such as hospital readmission rates.

Mr Cameron said ministers had "learned a lot about how to make our plans better" during the two-month consultation.

"We have listened and engaged and not just heard what people have said but we are going to reflect it in what we are going to do. There are real changes being made to these health reforms to reflect the concerns of patients, doctors and nurses so we get that right."

As part of efforts to reassure the public about the changes, he also set out "five guarantees" which he said would protect the "precious idea" underpinning the NHS.

He said the NHS would remain a universal service, changes would improve "efficient and integrated care", hospital waiting times would be "kept low", NHS budgets would increase every year and there would be no privatisation nor cherry-picking by private providers.

"There can be no compromise on this. It is what patients expect. It is what doctors and nurses want. And it is what this government is determined to deliver."

'Panic move'

Plans to modernise the NHS have caused tension between Conservative and Lib Dem coalition partners and ministers have already conceded there would be substantial alterations to the Health and Social Care Bill as a result of the consultation.

Deputy Prime Minister and Lib Dem leader Nick Clegg told a meeting of his MPs and peers on Tuesday that the reforms were now "on the right path".

According to aides present at the meeting, Mr Clegg said his party's insistence on major changes had forced the Tories to "move quite a bit".

But his Lib Dem colleague Andrew George earlier said the proposals amounted to a "U-turn" and the entire legislation should return to Parliament for detailed scrutiny by MPs.

The BBC News Channel's chief political correspondent Laura Kuenssberg said these were very real changes to the original plans drawn up by Health Secretary Andrew Lansley and would raise concerns among some Tory MPs about whether the health service was really being simplified.

For Labour, Ed Miliband said the proposed shake-up would divert hundreds of millions of pounds away from patient care, at a time the NHS was expected to find £20bn savings.

"I think the reason why the prime minister is in such a panic over the NHS is because he knows that this is a total breach of the promises he made at the election," he said.

"He promised no top-down reorganisations, he went to nurses' conferences and promised that and now he's doing the opposite... in the most cack-handed way."

'Right direction'

Organisations representing NHS professionals reserved their judgement on the changes, saying they wanted to see the full details.

The British Medical Association said greater input from doctors and nurses was a "step in the right direction" but there must be clarity on competition between providers.

"The prime minister's speech suggests he is committed to integrated NHS services," said its chairman Dr Hamish Meldrum. "However, he also spoke in glowing terms about the benefits of competition. We would point to the many damaging effects its application in the NHS has had so far."

The Royal College of Nursing said standards of care, not cost control, should drive the government's approach.

"If you just worked on the basis of cost, you would have the cheapest providers - cheap care is often poor care and poor care often ends up being more expensive," its chief executive Dr Peter Carter said.

The Health and Social Care bill has been on hold pending the outcome of the consultation. According to the Department of Health, 8,000 people took part in 250 events, 2,400 public comments were submitted via a government website and 970 comments submitted privately.

The BBC understands the NHS Future Forum report, which will formally recommend any changes, will be delivered to cabinet either next Monday or Tuesday.