Healthcare experts have said new powers for ministers over the NHS should be stripped out of legislation being debated by MPs on Wednesday.
As the first major reforms of the health service in almost a decade come before MPs for a second reading of the Health and Care Bill, ministers were facing calls to row back on sweeping powers that would granted to the health secretary Sajid Javid.
There also calls by thinktanks, experts and charities to change the legislation to require workforce projections for the NHS to be published annually showing whether the health service will have enough staff to meet future demand.
Former health secretary Jeremy Hunt said “this single measure would make the biggest difference” ahead of the debate.
While the bill is designed to bring about a new way of working for the NHS, with more integration between local organisations so that care for patients is more joined-up, the bill also includes an array of measures that experts say could lead to politicians interfering in the day-to-day work of the NHS and endangering patient safety.
The proposals include powers for the health secretary to intervene in any local changes to health services, raising fears that changes needed to improve care will be delayed or stopped because political rather than clinical considerations.
Sajid Javid will also have the power to issue directions to NHS England and the ability to transfer powers and responsibilities between national organisations without primary legislation being needed.
Helen McKenna, senior fellow at The King’s Fund, told The Independent: “The new powers for the Secretary of State to intervene in local service changes need to be stripped out of the bill.
“As currently drafted, these clauses bring the risk of political expediency trumping clinical judgement in these important decisions.
“These powers could lead to any service change in the NHS potentially landing on the Secretary of State’s desk, risking a decision-making log jam – a far cry from the government’s stated ambition to reduce bureaucracy.”
The Nuffield Trust thinktank added: “We are concerned that these new powers will result in a more politicised NHS, with ministers dragged into micromanaging how local services work. In the past, health secretaries under political pressure blocked changes now regarded as having saved lives – for example, the stroke care reorganisation in London.”
As MPs were preparing to debate the legislation on Wednesday afternoon, opposition to the proposals was growing. The Labour Party has said it will vote against the the legislation and the British Medical Association has also come out against it.
The BMA said it was the wrong time to reorganise the NHS and the measures did not do enough to address the workforce shortages in the NHS.
It also claimed the bill does not protect NHS services from more outsourcing to private companies – despite the bill explicitly removing a requirement on the NHS to put services out to tender.
Richard Murray, chief executive of The King’s Fund, said the existing NHS system led to unnecessary and costly contracting which the new measures would end and would make it easier for services to remain with existing providers like the NHS.
He added: “The rule change should give more scope to buy services from the best provider in a local area, rather than working through cumbersome and bureaucratic processes. These decisions will still need to be justified against set criteria.
The new bill will create 42 integrated care boards who will have responsibility to provide services for people living in their area. These boards will bring together NHS organisations as well as local councils and other bodies to work towards better services.
But The Nuffield Trust said while the intentions in the bill were good: “This complex, overlapping structure might lead to gridlock. In areas where relationships are not very good the different players locally, each with their own legal duties to follow, could resist any changes that go against their interests through the multiple different planning and consultation processes. These processes may take up a great deal of NHS managerial time.”
It also warned there was a danger that poorer areas could lose out in the way funding was allocated because the ICBs will be four or five times larger than existing clinical commissioning groups which will be abolished.
The Health and Care Bill also includes
- A requirement for the health secretary to publish an assessment of NHS workforce planning at least once every five years.
- It removes aspects of competition law and barriers to NHS trusts merging.
- The Healthcare Safety Investigation Branch will be given formal independence and powers to investigate safety incidents. Information will not be able to be used against doctors or nurses. The health secretary will have the power to direct it to investigate incidents.
- The Care Quality Commission will be given expanded powers to inspect local authority services.
- The health secretary will be able to provide funding directly to social care providers.
- Powers to deregulate some healthcare roles and to merge together other regulators such as the General Medical Council and Nursing and Midwifery Council.
- Establishing the role of medical examiners within NHS trusts in law.
- New laws on calorie labelling on food and drink packaging and the advertising of junk food before the 9pm watershed.
- The government will also have the power to add fluoride to drinking water.