Health secretary makes the rare step of making a Commons statement on his bill as it passes through parliament
The health secretary, Andrew Lansley, is to launch a last-ditch attempt to rescue his controversial NHS reforms by accepting that the membership of new GP-led consortiums needs to be widened.
Lansley will on Tuesday agree with the broad principles of proposals made by the health select committee, chaired by John Major's last health secretary, Stephen Dorrell, although he will resist many of the detailed recommendations.
Lansley was forced to announce to MPson Monday that he would amend his plans, during a "natural break" in the passage of the heath and social care bill. His reforms would hand 60% of the NHS's £103bn budget to new GP-led consortiums.
Government sources said he was studying carefully proposals by the committee, which warns that GPs should not be the sole commissioners of care in the NHS. In a report it calls for GPs to share commissioning powers and responsibility with nurses, consultants, public health experts and patients.
Lansley, who met David Cameron in Downing Street on Monday, took the rare step of making a statement to MPs about the progress of a bill which has still not completed all its stages in the Commons.
In a sign of nervousness in Downing Street, which fears that the public backlash is jeopardising Cameron's work in persuading the public that the NHS is safe in Tory hands, Lansley will accept some of the broad principles in the health select committee report.
"Some of the ideas suggested by the committee are in sync with the government's thinking on how, for example, others might be involved in the GP consortia," one Whitehall source said.
But Lansley will not accept all of Dorrell's ideas because he believes they would put too many groups in the new GP-led consortiums. "It is wrong to assume that the health select committee is telling the secretary of state what to do," the source said. "This is an evolutionary process."
Dorrell admitted that his reworking of the bill "is not minor tweaking". He said: "We believe it is crucial to get the reform of NHS commissioning right if the service is to confront the massive financial challenge it now faces. Our report contains a set of practical proposals to strengthen the health and social care bill and make it better able to meet the government's objectives.
"Our proposals are designed to ensure that NHS commissioning involves all stakeholders – GPs, certainly, but also nurses, hospital doctors, and representatives of social care and local communities. We believe this broadening of the base for commissioning is vital if we are to achieve the changes that are necessary to allow the NHS to deliver properly co-ordinated healthcare."
The signals that the government was prepared to accept some of the principles behind the Dorrell report came as Lansley acknowledged that people have "genuine" concerns as he announced that the government would table amendments to the bill.
Amid fears in Downing Street that Lansley has failed to explain the thinking behind his reforms, the health secretary said he would use a "natural break in the passage of the bill" to offer reassurances that the government's sole intention is to improve the NHS.
The bill completed its committee stage last week. No date has been fixed for its report stage, the penultimate hurdle before it goes to the House of Lords.
In a sign of Lansley's isolation no full voting member of the cabinet, apart from ministers on other business, sat with him on the frontbench. Lord Tebbit, the former Conservative chairman, criticised the plans in the Daily Mirror.
Lansley will outline the amendments at a joint appearance later this week with the prime minister and Nick Clegg. The health secretary told MPs the amendments will make clear there will be no backdoor privatisation of the NHS; Lansley told MPs: "Choice, competition and the involvement of the private sector should only be a means to improve services for patient, not ends in themselves. Some services like accident and emergency or major trauma clearly will never be based on competition." the private sector will not be allowed to cherry-pick the most profitable parts of the NHS; and there will be greater transparency and accountability of the new consortiums. Lansley said: "People want to know that the GP commissioning groups cannot have a conflict of interest, are transparent in their decisions and accountable not only nationally but locally, through the democratic input to health and wellbeing boards."
Under the committee's proposals, the GP consortiums would become NHS commissioning authorities and would no longer be merely the province of GPs. GPs should take a majority of the seats on the authority, says the report, but there should also be places reserved for a professional social care representative, an elected member of the local authority, a nurse, a hospital doctor and a public health expert.
This wider membership is necessary to ensure commissioning bodies, which have responsibility for spending large amounts of taxpayers' money, "comply with the highest standards of governance and accountability", says the committee.
It would also help break down the barriers between primary, hospital and community care, with the commissioning authorities responsible for commissioning all of it, as well as forging closer links with social care.