Will the House of Lords take an axe or a scalpel to the Health and Social Care Bill?

Written by Tony Millett on .

Tomorrow (Tuesday, October 11) the coalition government’s Health and Social Care Bill for its major reorganisation of the NHS, reaches the House of Lords.   And there is great speculation that their Lordships may insist on some basic alterations to Secretary of State for Health, Andrew Lansley’s plans.

Well before Lansley’s policy even became a Bill, changes were set in motion.  Locally they are already well underway – but there’s a certain anxiety about the “continuously changing” guidance from Whitehall.

The North and East Wiltshire (NEW) clinical commissioning group (CCG) – which will cover the Marlborough area, taking over the responsibilities of NHS Wiltshire (the PCT)  – has been re-writing its business plan after its first version was turned down by the Primary Care Trust and the Strategic Health Authority.  The GP leading NEW’s application, Dr Jonathan Rayner, told Marlborough News Online that its interim board have now re-submitted their plan and it comes up for approval this week.

The other two Wiltshire CCGs (south Wiltshire – known as Sarum – and west Wiltshire – known as WWKYD) have had their business plans accepted and are already working with the PCT.

There will be another audit of Wiltshire’s CCGs at the end of this month to make sure they are sufficiently big and robust to be sustainable.  In September the Department of Health issued a ‘ready reckoner’ to flush out CCGs that could not afford the necessary support systems to take over the PCT’s role of commissioning primary health care services.

So far NEW has appointed a part-time financial manager and will shortly be appointing a manager for the everyday running of the CCG.

The burden of work the new commissioning arrangements will place on local GPs is still to be finalised – or realised.  Dr Rayner, who works at the Ramsbury and Wanborough medical practices, told Marlborough News Online that he’s limiting his administrative work “to a maximum of one day a week – I don’t want to do more than that – if it’s more than that, we’d have to do something different.”

This illustrates one of the problems with the government’s plans.  They want to put more money into frontline services as opposed to back-room office ‘bureaucrats’, but they then take front line doctors out of their surgeries to run the commissioning groups and race round the county attending meetings.

The critics say that the CCGs may decide to employ outside agencies to run their commissioning for them – creating mini-PCTs.  One of the LibDems demands when the coalition’s Bill was taken off Parliament’s agenda for a re-think – the so-called ‘pause’ – was that CCGs should not outsource commissioning to outside agencies.

If a CCG is deemed to be too small or its doctors will not devote enough of their time to commissioning, then some CCGs may be told to merge – in the process losing most of the local control that Mr Lansley’s White Paper promised.

There’s a lot of learning to be done.  Both the PCT and the strategic authority have been offering training sessions for the GPs.  And two of NHS Wiltshire’s experienced non-executive directors are being seconded to work alongside each of the three CCGs.

The CCGs are even being offered free media training so they can cope with the forensic questioning of the local media.

So far NEW has an interim board.  Soon NEW will have to appoint its non-GP members (probably a consultant and a nurse) and patient representatives.   But the precise rules on who is eligible for these roles have not yet been finalised in Whitehall.  NEW’s chairman, Simon Burrell (of Corsham) will probably present the CCG on Wiltshire Council’s Health and Wellbeing Board which will have a new strategic and oversight role.

The elephant in Mr Lansley’s office is a large one: if – and it’s a very big if – the Lords killed the Bill, how would the NHS continue now that so much change has been imposed before the Bill becomes law.  Watch this space…