The original proposals in the Health and Social Care Bill
- The explicit duty on the Secretary of State to provide or secure the provision of a comprehensive health service removed.
- Widespread powers for the Secretary of State to intervene if national bodies fail to perform their functions.
- No specific requirements about how consortia should be governed.
- Duties on GP commissioning consortia and the NHS Commissioning Board to involve patients in commissioning decisions.
What has changed in the proposed reforms?
- The Secretary of State's duty to promote a comprehensive health service restored. Secretary of State will be ultimately accountable for securing the provision of services – this duty will be exercised through the NHS Commissioning Board and other bodies.
- Secretary of State now able to intervene only if institutional failures are 'significant'. New requirement on NHS Commissioning Board and clinical commissioning groups to promote the NHS Constitution.
- Clinical commissioning groups required to have a governing body that must adhere to Nolan Principles. Two lay members must be included to champion public and patient involvement and lead on governance.
- Governing bodies must meet in public, with minutes of meetings and details of contracts to be published.
What is still unanswered?
- How will the rights contained within the NHS Constitution be guaranteed?
- How will the Prime Minister's pledge to keep waiting times low be measured and enforced?
- Will the pathfinder scheme for commissioning consortia be properly evaluated and lessons learned to inform the roll-out of clinical commissioning groups?
- Will the more prescriptive approach now set out in the Bill lead to over-centralisation and discourage locally led innovation?