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Risk of 'paralysis' as legislation enters House of Lords

We are calling on the House of Lords to reduce the threat of the NHS being "paralysed by fuzzy structures and decision making processes" that would prevent it from dealing with financial pressures and improving quality of care.

briefing for peers ahead of a major parliamentary debate on 11 October, at which nearly 100 peers are expected to contribute,
makes clear that it supports a number of the key principles in the Bill.   


We are unconvinced that the reforms, as currently constructed, will deliver a coherent system that will enable the NHS to tackle its most significant challenges. We believe the reforms do not directly address the financial pressures and that the jury is out on whether they will improve care for patients. 

Calling on peers to get fundamentals right

We want peers to make sure they get the fundamentals right in areas such as the accountability of the key players in the healthcare system including the Secretary of State. And we want  them to take practical steps that would help the NHS deal with its most pressing problems. 

Mike Farrar, NHS Confederation chief executive, said: "There is support for some of the principles in the Bill but at a practical level it has few enthusiasts and we need the Lords to help give the reforms a fighting chance of success.  

"They still need to sort out some of the fundamentals - the accountability of all the key players in the system must be crystal clear, not least of the Secretary of State. And we also need peers to get beneath the surface of the legislation and give us the practical tools we need to tackle the major problems we face.   


"We need the NHS to be given the freedom it needs to tackle its financial pressures and deal with variations in quality of care. I worry that it will end up paralysed by fuzzy structures and decision making processes, with few powers to take charge of its destiny. It is still unclear that the NHS reforms do what has been said on the tin.“ 

Getting real on big issues

Mr Farrar added: "We need to get real about the big issues if the NHS is to avoid falling into serious financial difficulty while also improving quality of care. We need a Bill that helps us make radical changes so we can concentrate services and offer more care in the community. The evidence shows this can mean better care for patients. We can then also shut down unwanted capacity and make savings.  

Avoiding red tape

"Up and down the country, NHS leaders have plans to meet this challenge. These plans need proper and robust scrutiny but it will serve nobody if good projects get strangled by red tape. The Lords should make sure the system is improved so consultation on major change becomes more straightforward. This means defined time limits for how long decisions can take and clear roles for organisations involved." 

What we're calling for

We believe the reforms must:

  • support a speedy process for making decisions about reconfiguration
  • ensure clinical commissioning groups have freedom to make decisions - clinical senates should not veto commissioners' plans
  • specify precisely the roles and responsibilities of all the various bodies in the system in order to minimise confusion. 

Our briefing also raises points about: 

  • achieving the right the balance of power between the National Commissioning Board and local Clinical Commissioning Groups (CCGs)
  • clarifying that decisions on competition, choice and integration will be made locally in the interests of patients, within a national framework
  • championing rather than denigrating the role of NHS leaders, especially for CCGs which will need adequate leadership resources
  • making sure the whole system works by being clear about intervention when quality and finances slip so as to prevent major failure.

Representing members

During the last few months we have also met a number of key peers and we will continue to do so before Committee stage. 

Recently, we have met:

  • Earl Howe (health minister)
  • Baroness Cumberlege (Conservative)
  • Baroness Jolly (Liberal Democrat health lead)
  • Baroness Northover (Liberal Democrat health whip)
  • Baroness Williams (Liberal Democat)
  • Lord Alderdice (Liberal Democrat)
  • Baroness Thornton (Labour health lead)
  • Lord Hunt of King’s Heath (Labour sector regulation lead)
  • Baroness Wheeler (Labour)
  • Lord Warner (Labour)
  • Lord Rea (Labour)
  • Lord Turnberg (Labour)
  • Lord Touhig (Labour)
  • Lord Winston (Labour)
  • Baroness Young (Labour)
  • Lord Darzi (former Labour minister)
  • Baroness Morgan of Dreflin (Crossbencher)
  • Lord Crisp (Crossbencher; ex-NHS Chief Executive)
  • Lord Patel (Crossbencher)
  • Baroness Masham (Crossbencher).

Deputy director of policy Jo Webber will also brief crossbench peers at a Managers in Partnership (MiP) event at the House of Lords on 10 October. 

Keeping members informed

We will keep members up-to-date with the Bill’s progress in the Lords and any significant changes that are made.


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