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4 April 2011

How much “listening” will Cameron do on the NHS?

The PM plans to delay NHS reform for three months but what concessions will he offer?

By George Eaton

The “breakneck coalition” has hit another bump in the road. David Cameron has bowed to the inevitable and put the government’s NHS bill on hold for the next three months while ministers agree on the way forward.

The announcement of a delay will be made at a joint event later this week involving Cameron, Andrew Lansley and, notably, Nick Clegg, whom the PM is determined to bind in to the changes.

It remains unclear whether the delay is merely part of a “listening exercise” or a prelude to significant concessions on competition, the role of the private sector and GP accountability. What we won’t see is a U-turn akin to that on forest privatisation. Cameron is too personally committed to the reforms to change course now. The shadow health secretary, John Healey, has rightly warned that “simply doing the wrong things more slowly is not the answer”.

The Lib Dem opponents of the reforms, led by Evan Harris, issued a list of “essential amendments” last night, described as “the minimum” needed to satisfy the party’s members. Of the 23 proposed amendments, here are the most significant:

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Elected councillors to sit on GP consortiums

“Membership of local commissioning bodies to include a substantial proportion of elected councillors as per Coalition Agreement to improve transparency and accountability.”

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Piloting of the reforms

“The changes to commissioning to be piloted and evaluated before full roll-out.”

A ban on “cherry-picking” by the private sector

“Commissioning to be governed by a requirement/duty on commissioners, when considering contracting with any new provider – or offering the choice of a new provider – to be satisfied that broader service stability is safeguarded and that cherry-picking and cream-skimming are avoided.”

Constraints on EU competition law

“Statutory provision to ensure that provision of clinical services to the NHS is not governed by current EU and UK competition law to a greater extent than is the case now. In particular to provide that vertical integration of services is not impeded by competition law.”

Lansley, who has already given ground on price competition, is thought to be willing to agree to restrictions on “cherry-picking” and on the role of the regulator Monitor. The government had originally hoped to make changes to the bill in the Lords but, under pressure from Clegg, it is now likely to do so in the Commons. The principles of the bill, ministers insist, will remain in place.

In an attempt to seize the initiative, Ed Miliband will offer cross-party talks to develop “replacement plans” in a speech this morning. Cameron may dismiss the Labour leader as a “roadblock”, but he has handed him the sort of opportunity that opposition leaders dream of.

Lansley’s technocratic style means that the coalition has allowed the reforms to be defined by the media. As a consequence, it will struggle to convince a sceptical public that the changes are “practical” as opposed to ideological. With the coalition’s higher education plans also in chaos, ministers have been taught a salutary lesson in the perils of hasty reform.