Please find below my thoughts and responses to some of the more common concerns and subjects of campaign emails.

Proposed NHS reforms

Proposed NHS reforms

Department of Health's 'risk register'

I do understand your interest in this information. However, it is important to be clear what risk registers include and what they do not. Risks and benefits related to the Health and Social Care Bill are already in the public domain in the Department of Health's impact assessments, and are available on the Department's website (www.dh.gov.uk by searching for 'Health and Social Care Bill: combined impact assessments.') These have been updated as recently as September. In contrast, the Departmental risk registers – which have not published – set out the full range of risks for all activity over which the Department of Health is responsible.

Risk registers are used across Government. They set out financial and policy risks, as well as sensitive commercial and contractual risks. They are a tool through which information about risks, however improbable of becoming a reality, can be recorded to enable the risks to be managed and mitigated. They therefore play a critical role in the delivery of effective government.

The Information Commissioner's decision to order the release of the Department of Health's risk registers therefore creates a precedent that would have implications across the whole of Government. There is a real danger that if risk registers are routinely released into the public domain, then risks would no longer be recorded accurately on them. Establishing this precedent would threaten the successful implementation of Government policy. After careful consideration, across Government, the Department of Health has decided to appeal the decision by the Information Commissioner.

While the Department remains of the view that there is information contained within the risk register that should not be disclosed for the reasons already set out, it is aware of the public and parliamentary interest in this issue. The Department has acknowledged that arriving at an early solution would be beneficial to all concerned.

I am pleased that, for this reason, the Department has encouraged the Tribunal to schedule the hearing for as early a date as possible, while allowing of course for both sides to make the appropriate preparations. Following this the Tribunal has brought the hearing forward from its initial date in April, to a date in early March.

I do not think it appropriate to comment further on this issue until the outcome of the Tribunal is known. The Department will respond when the Tribunal has made is its decision.

The Secretary of State's legal duties

Under the existing NHS legislation, the Secretary of State has never had a legal duty to provide – only a duty to promote – a comprehensive health service.

This duty remains unchanged by the Health and Social Care Bill, as it has since 1946. I would like to assure you that the Secretary of State will retain overall accountability for the NHS. Currently, the legal duty to deliver 'a comprehensive health service' free at the point of need lies with Primary Care Trusts (PCTs).

The new legislation will abolish PCTs and create Commissioning Consortia, composed of local healthcare professionals in each local area – similar to PCTs, but more accountable. The legal duty will transfer to them from the PCTs.

Therefore, the legal duty will not lie with the Secretary of State, as indeed it has never done. The Commissioning Consortia will be answerable to the Secretary of State, and therefore Parliament, as the PCTs currently are. I would like to assure you that the Secretary of State will retain overall accountability for the NHS.

Concerns raised by the British Medical Association

Thank you for contacting me about the Health and Social Care Bill and the British Medical Association (BMA) campaign.

I am a great advocate of the National Health Service and I believe that Government should continue to explore ways of improving the service that the nation relies on. It has taken the opportunity to listen to healthcare professionals and after receiving their advice, it has made several amendments to the Bill to better reflect these expert opinions. I am disappointed by this campaign as the BMA previously said it was 'pleased that the government has accepted the Future Forum's core recommendations and that there will be significant revisions to the bill'.

I believe that it is right that patients are given a choice about where they get there healthcare from. This will give them greater control over their healthcare and ensure that they get the care that is most appropriate to their needs. I recognise that this will need to be regulated and I am confident that the Government's amendments to the Bill are addressing this. Monitor, the healthcare regulator, and a new NHS Commissioning Board will produce guidance on how choice and competition should be applied to services and Monitor's powers will be strengthened to protect services being subject to competition abusive practices. Moreover, private providers will not be able to 'cherry-pick' services and competition will be based on quality, not price, better reflecting the needs of patients and not profiting private providers.

Secondly, this Bill will have positive implications for NHS service delivery and the quality of care provided. Promoting integrated service delivery will bring a range of expert advice to commissioning services and providing care which will be focused around patient need. In response to the NHS Future Forum recommendations, the Government will also ensure a safe and robust transition for the education and training system and has set out broad proposals which would see healthcare providers contributing to the cost of education and training.

Thirdly, these reforms will create a system of localised healthcare provision that reflects the needs of local communities. There are more opportunities for integrated care, greater safeguards on competition and stronger accountability. It is because of a desire to maintain the 'patient comes first' ethos that the Government is giving patients a choice of provision. I believe this will allow patients to get the most suitable care that suit their needs and the increase in fair competition will ensure that this care remains patient-focused.

The reforms will enhance the quality of care and will protect the core values of the NHS, that patients will get the highest quality of care that is free at the point of delivery.

The abortion counselling amendment

I welcome the Government's intention to consult on abortion counselling later this year.

I am sympathetic to the aim of ensuring that all women considering an abortion are offered independent counselling. This would certainly provide women with greater choice, and an ability to decide for themselves where that advice comes from.

Votes on abortion are matters of conscience. However, I am aware that health ministers have always intended to vote against the amendments which may be debated this week because they would prevent abortion service providers offering counselling, therefore the amendment would still place limits on who could provide women with counselling, and would consequently represent a change but not an improvement to the current system. I will therefore be voting against the amendment if the Speaker selects it.

However, had the Speaker selected the amendment tabled by Louise Mensch MP, I would have been happy to vote in favour of it, because the crucial difference is that her amendment proposed to allow a much fuller choice for women considering an abortion. She is proposed that women should be able to seek independent advice, either from the clinics themselves or from other independent sources, and crucially it would be the NHs administering the provision of information.

The forthcoming consultation on counselling does not represent a moral shift in the Government's position on abortion. The laws governing abortion are set out in the abortion act, and are for parliament to decide on the basis of a free vote.

Competition laws and the NHS

Competition laws apply within the NHs under existing legislation and will apply in the future. The proposed legislation does not alter how domestic and European competition laws are applied to the NHS.

Overview of proposed changes

The Government will never stray from the NHS's founding principles – that the NHS delivers healthcare to all, free at the point of use, funded from general taxation, and based on need and not ability to pay. That is why it is increasing investment in the NHS - something that Labour opposes.

Investment alone is not enough. Demands on the NHS grow all the time, and every day dozens more lives could be saved if our healthcare was up at the levels of the best – 10,000 more lives a year from cancer alone. That is why we the Government is cutting back on the waste of the previous administration, and giving power to doctors and nurses. To protect the NHS for future generations, it needs to modernise. Unlike the previous administration, this Government will not rig the NHS market in favour of the private sector. The less complex the procedure, the less someone – including in the private sector – will be paid.

REFORM SUMMARY

The Government's Health and Social Care Bill 2011 includes key proposals to:

give new clinical commissioning groups across England the task of commissioning the healthcare they deem appropriate for their patients, and control over a proportion of the NHS budget to pay for these services;

make the NHS more accountable to patients and the public by establishing HealthWatch, a new independent body to investigate complaints and scrutinise the performance of local health providers;

establish a new body, Public Health England, to improve public health and reduce health inequalities between the richest and poorest, and;

cut the bureaucracy of the NHS by abolishing Primary Care Trusts (PCTs) and Strategic Health Authorities (SHAs) by 2013, reducing NHS management costs by 45 per cent, and scrapping a number of arm's length bodies and quangos

EXECUTIVE SUMMARY – HEALTH AND SOCIAL CARE BILL BACKGROUND

The Coalition Government's Programme for Government made clear its ambition to drive up standards, support professional responsibility, deliver better value for money and create a healthier nation. The Health Secretary, Andrew Lansley MP, stated the Government's intention to always adhere to the core principles of the NHS; a comprehensive service for all, free at the point of use, based on need not ability to pay.

In July 2010 the Government unveiled an extensive package of reforms to the NHS in England in its July 2010 White Paper Equity and Excellence: Liberating the NHS. The White Paper set out the Government's aims to reduce central control of the NHS, to engage doctors in the commissioning of health services, and to give patients greater choice. The Health and Social Care Bill, published on 19 January 2011, would give effect to those reforms requiring primary legislation.

NHS FUTURE FORUM

In April 2011, following the Bill's first Committee Stage, the Health Secretary announced a pause in the legislation to get the opinions of health professionals that would help shape the future proposals set out in the Bill.

The NHS Future Forum consisted of a group of clinicians, patient representatives, voluntary sector representatives and others from the health field, including frontline staff. It was chaired by Professor Steve Field, Chairman at the Royal College of GPs, and was asked to report to the Prime Minister, Deputy Prime Minister and the Secretary of State for Health on the following four themes:

the role of choice and competition for improving quality;how to ensure public accountability and patient involvement in the new system; how new arrangements for education and training can support the modernisation process; andhow clinical advice and leadership from across a range of healthcare professions can improve patient care.

NHS FUTURE FORUM – GOVERNMENT RESPONSE

In June 2011 the Health Secretary accepted the report recommendations and set out the Government's response. The Government understood that the recommendations confirmed that the principles underpinning the plans for modernization are the right ones but that improvements for patients and the NHS could still be made.[7]The Government intends to make significant changes to implement the Forum's recommendations.

Summary of changes

Overall accountability for the NHS

The Bill will make it clear that the Secretary of State has a duty to promote a comprehensive health service. They will be accountable for securing its provision and for the oversight of the national bodies charged with doing so, and also for maintaining a system for professional education and training and for promoting research.

Clinical advice and leadership

GP consortia will be renamed 'clinical commissioning groups.' The Bill will be amended so that the governing body of every clinical commissioning group will have at least two lay members, one focusing on public and patient involvement and the other overseeing key elements of governance, who will be required to meet in public.

In addition commissioners would be supported by existing and new clinical networks advising on single areas of care, such as cancer, and new 'clinical senates', in each area of the country, that would provide multi-professional advice on local commissioning plans. Both would be hosted within the NHS Commissioning Board.

Public accountability and patient involvement

The Future Forum agreed with the Government that patients and carers should be at the heart of the NHS but to make this second nature in the NHS the Government plans to make sure that there are clearer duties across the system to involve these groups.

There are also plans to strengthen the role of health and wellbeing boards in local councils, ensuring that they are involved throughout the commissioning process and that local health service plans are aligned with local health and wellbeing strategies.

Competition and patient choice

The Bill will be amended to strengthen and emphasise the commissioners' duty to promote patient choice. The choice of any qualified provider will be limited to areas where there is a national or local tariff, ensuring that competition is based solely on quality. The tariff development, alongside a best-value approach to tendered services, will safeguard against cherry-picking.

In relation to competition, Monitor's core duty would be to protect and promote the interests of patients, and not to promote competition as though that were an end in itself. Instead its duty to support services integrated around the needs of patients and the continuous improvement of quality.