Final vote for the bill ended more than a year of debate and several last-minute attempts to overturn or delay the legislation
The health secretary, Andrew Lansley, begins the hard task of rebuilding confidence in the NHS after the biggest reorganisation in the history of the health service cleared its last parliamentary hurdle.
The final vote for the health and social care bill ended more than a year of debate and several last-minute attempts to overturn or delay the legislation. Labour used the final day’s debate to declare that it would repeal the reforms “at the first opportunity”.
After a year in parliament, more debate and scrutiny than any bill in living memory and more than 1,000 amendments in the Commons and Lords, MPs were expected to pass the final vote. The government bill will be sent to the Queen for Royal Assent and is expected to become law early next week.
At the heart of the bill are plans for a radical restructuring of the health service in England. It will give GPs control of much of the NHS’s £106bn annual budget, cut the number of health bodies and introduce more competition into providing services, all with the intention of reducing administration costs by a third – which the government says is essential if the health service is to cope with the ever-rising cost of caring for an ageing population offered new, expensive medicines and treatments.
Mike Farrar, the chief executive of the NHS Confederation, said: “Let there be no doubt this will be among the toughest projects the NHS has ever taken on.
“We have to find our way through the considerable confusion and complexity that has been handed to us as we build and stress-test the new NHS system. We need to heal the rifts that have opened as many of our clinical staff have debated the merits of the bill. We need to completely redesign NHS services against a backdrop of unprecedented financial pressure, bringing the public and staff with us. We have to do all this with significantly reduced management capacity.”
Among the challenges facing the government’s reforms will be whether they can deliver the promised £20bn of efficiency savings without waiting lists and other key improvements going into reverse. There are also doubts about whether all the changes will be allowed under EU competition law.
The shadow health secretary, Andy Burnham, ended his final speech with a reminder to Conservative and Liberal Democrat MPs without clear signs of success, the two parties run the risk that every problem with the NHS will be blamed on the reorganisation during a time of financial cuts. “We will remind them every day of the damage they have done to our NHS.”
Health secretary Andrew Lansley will now be trying to mend relationships with professional bodies. Over the next few months, focus will be on consultations about another major plank of the reforms: the NHS mandate, under which the government will set targets for quality or improvement in 60 or so areas of health care, such as patients surviving after cancer treatment. The national NHS commissioning board will then consult NHS bodies on how to meet those targets.
“Everybody is a bit bored of talking about the processes and structures: it was a very important debate, but we all want to get back to talking about people’s health and making people better,” said a Department of Health source.
The final vote on the bill followed a last attempt by Labour and a few Lib Dems to delay the final act, by winning a 90-minute emergency debate calling for the Department of Health’s register of the risks associated with the new policy to be published before MPs cast their last vote – the third such intervention in four weeks.
The information commissioner and an information tribunal have ruled that the department should publish the transition risk register on the health bill, but ministers have continued to hold back publication, saying they need to see the tribunal’s explanation of their decision before they consider a further appeal.
The motion was, for the third time, comfortably defeated in favour of the government. Recognising the likely defeat, Burnham said: “While on a day like today it’s hard for me to give any encouragement to people worried about what this government is doing, I can at least say this: that we will repeal this bill at the first opportunity and restore the N in NHS.”
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