NHS reforms: We will address &#39;legitimate&#39; concerns, says Nick Clegg

Deputy PM seeks to reassure critics of shake-up as Commons health committee urges rethink of proposals in health and social care bill

The deputy prime minister, Nick Clegg, promised to address "legitimate" concerns over the government's controversial NHS reforms as MPs called for significant changes to the plans.

The cross-party Commons health committee urged a rethink, with its chair, Stephen Dorrell, saying it was not a case of merely recommending "minor tweaking" of the health and social care bill.

The publication of the committee report comes as Clegg and the prime minister, David Cameron, prepare to launch a "listening exercise" this week in an attempt to reassure critics of the shake-up.

The Liberal Democrat leader ? who faced pressure from within his party last month over key elements of the bill ? said the government would listen to "legitimate" concerns about the bill, currently going through parliament, and that there could be "substantial" changes.

Clegg said: "The NHS is not the government's property. We want people to feel comfortable with the changes, which will strengthen, and not weaken, the NHS."

In a sign of nervousness in Downing Street ? which fears the public backlash is jeopardising Cameron's work in persuading the public that the NHS is safe in Tory hands ? the health secretary, Andrew Lansley, will accept some of the broad principles in the health select committee report, although he will resist many of the detailed recommendations.

Lansley, who met David Cameron in Downing Street on Monday, took the rare step of making a statement to MPs about the progress of a bill which has still not completed all its stages in the Commons.

He said he would amend his plans during a "natural break" in the passage of the bill, which sets out reforms that would hand 60% of the NHS's �103bn budget to new GP-led consortiums.

Government sources said he was carefully studying proposals by the committee, which calls for GPs to share commissioning powers and responsibility with nurses, consultants, public health experts and patients.

Clegg said he believed it was an "uncontroversial idea" to hand GPs more responsibility.

He told BBC Breakfast: "It is a rather good idea to have them in the driving seat, rather than unaccountable officials who are moving money around from one side of the desk to the other.

"But, yes, with responsibility must come more accountability, which is precisely why we will be looking at these concerns, and will be looking to amend the legislation to reflect that."

He added that "a number of very significant amendments and improvements" had already been made to the bill.

Addressing concerns about competition, he said: "There isn't going to be a bargain basement rush to the bottom, because there isn't going to be competition based on price."

In comments reflecting the concern of grassroots party members, who last month voted overwhelmingly for on a ban on "cherry picking" by private companies, Clegg added: "We want to be very, very clear ? we're not going to allow cherry-picking.

"We're certainly not going to allow vital parts of the NHS, like A&E, to be suddenly open to competition."

The committee, chaired by John Major's last health secretary, Stephen Dorrell, recommended a much bigger role for nurses, specialists and social care chiefs in deciding how services should be designed, together with tighter systems of governance and accountability.

All NHS commissioners, who would be GPs under the bill's proposals, should have a board chaired by an independent person as well as a chief executive and finance director, they recommended.

The boards should be forced to meet in public, and measures put in place to ensure no conflict of interest as a result of GPs commissioning services from private firms in which they have a stake.

The name "GP consortia" to represent groups buying services should be scrapped, and renamed "NHS commissioning authorities", the report said.

This would reflect an expanded role for other health professionals in commissioning, including nurses and hospital doctors.

As a result of the changes put forward by the committee, health and wellbeing boards in the bill could be scrapped, the report said.

The committee also called for commissioners to have a legal obligation to consult patients through HealthWatch, an organisation designed to ensure local views are taken into account.

"Some of the ideas suggested by the committee are in sync with the government's thinking on how, for example, others might be involved in the GP consortia," one Whitehall source said.

But Lansley will not accept all Dorrell's ideas, because he believes they would put too many groups in the new GP-led consortiums.

"It is wrong to assume that the health select committee is telling the secretary of state what to do," the source said. "This is an evolutionary process."

Dorrell admitted his reworking of the bill "is not minor tweaking". He said: "We believe it is crucial to get the reform of NHS commissioning right if the service is to confront the massive financial challenge it now faces.

"Our report contains a set of practical proposals to strengthen the health and social care bill and make it better able to meet the government's objectives.

"Our proposals are designed to ensure that NHS commissioning involves all stakeholders ? GPs, certainly, but also nurses, hospital doctors, and representatives of social care and local communities.

"We believe this broadening of the base for commissioning is vital if we are to achieve the changes that are necessary to allow the NHS to deliver properly co-ordinated healthcare."

H�l�ne Mulholland

Polly Curtis

Nicholas Watt

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