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13 June 2011
Last updated at 09:41 ET
By Nick Triggle
Health correspondent, BBC News
The government needs to make changes to its NHS plans for England to ensure the best interests of patients are protected, an independent review says.
The NHS Future Forum, which carried out a two-month consultation, called for the overhaul to happen more gradually.
The panel of experts also said it wanted to see a greater balance between competition and co-operation among NHS hospitals, charities and private firms.
Ministers are expected to respond to the recommendations on Tuesday.
They hope that by acting quickly they will be able to get their NHS reform programme back on track in weeks.
In April the government took the unprecedented move of halting the parliamentary progress of the Health and Social Care Bill underpinning the changes amid mounting criticism from academics, health unions and MPs.
GP power Ministers had originally wanted to hand GPs control of much of the NHS budget, while opening up the health service to greater competition.
But while GPs will remain in the driving seat, they should consult with other professionals.
Continue reading the main story “Start Quote
To ensure this happens, clinical senates made up of a variety of different experts including hospital doctors and nurses should be created to oversee the new system, the forum's report said.
The drive to create greater competition - perhaps the most controversial element on the plans - also needs changing, the panel said.
Originally, the regulator was to have a primary duty to promote competition, but that should be "significantly diluted".
The duty to promote competition should be removed altogether with competition only used as a means to improve services, the panel said.
The regulator, Monitor, should also not be called an economic regulator to allow it to focus on ensuring patients have choice, and so collaboration and integration between providers is encouraged.
The report also said consortia should only take on their responsibilities when they were ready.
Originally a deadline of 2013 was set, but the panel said the national board should take charge in individual areas until they were ready.
Professor Steve Field, the former head of the Royal College of GPs who led the NHS Future Forum, said while the principle of putting doctors in charge was well supported, he had heard "genuine and deep seated concerns" from many.
Continue reading the main story Analysis
Were the original plans for the NHS in England evolution or revolution? Do the changes proposed by the independent review represent a tinkering around the edges or wholesale changes?
For both these questions you get different answers depending on who you ask. In all probability only time will tell.
Take the issue of competition, much will rest on how the regulator interprets the legislation.
The response of GPs who will be driving the new NHS will also be key.
Pilots are already up-and-running, but it is possible that the review that has taken place could take the wind out of their sails.
When Labour launched its foundation trust policy to create elite hospitals free from political control it was a controversial and, it seemed, radical move.
Seven years on, most agree they have not really lived up to the original expectations. As always, the scale of change will depend on the actions of people - the doctors, nurses and managers on the front-line.
"If the substantial changes we propose are accepted by government then I think the resulting framework will place the NHS in a strong position."
Dr Hamish Meldrum, chairman of British Medical Association, said the government's approach during the listening exercise had been "refreshing" but this needed to be maintained in the coming months.
He added: "The Future Forum's recommendations address many of the BMA's key concerns, to a greater or lesser extent. We are hopeful that our missing concerns, such as the excessive power of the NHS Commissioning Board over consortia and the so called quality premium will be addressed as more detail emerges.
"Obviously, the critical factor is now how the government responds."
Professor Chris Ham, chief executive of the King's Fund think tank, gave the report his backing.
"The government must now move quickly to endorse today's report, put an end to the disagreements that have dominated recent months and provide the direction and stability the NHS desperately needs to navigate the challenging times ahead."
Sir Richard Thompson, president of the Royal College of Physicians, said changes to Monitor's role would be a "step in the right direction".
"The Health and Social Care Bill must clearly state that the primary focus of regulation is promoting integration, collaboration and quality - not promoting competition."
But Dave Prentis, general secretary of Unison, said: "The forum's changes may airbrush some of the flaws, but no amount of fiddling around around the edges is good enough when the future of the NHS is at stake."
Government mood Despite the formal announcement by government not being made until Tuesday, Prime Minister David Cameron has already accepted concessions will be made.
Last week he set out a series of areas he was planning to give way on. These chime closely with what the NHS Future Forum has now proposed.
Health Secretary Andrew Lansley thanked the Future Forum and said: "The Forum has been an invaluable source of expert advice and I have said we must keep listening on the NHS to deliver a world class health service.
"The Forum's reports show clear support for a health service that puts patients at the heart of everything it does, and where services are joined-up, accountable and focus on delivering better results for patients."
However, if the recommendations are accepted it remains to be seen whether that will be enough to satisfy all the competing interests.
The British Medical Association and other leading unions had wanted to see the role of competition downgraded much more.
While those who had been more positive about the plans had cautioned against making too many concessions which could, they have warned, compromise the ability of the NHS to cope with the twin challenge of rising demands and tightening budgets.
The political fall-out within the coalition is also being closely scrutinised.
On Monday Deputy Prime Minister Nick Clegg is expected to claim the Lib Dems have got their way in coalition battles over the bill when he meets his parliamentary party.
But backbench Tories have being vocal in expressing concerns the reforms are being watered down too much.
Labour has indicated it will be voting against the bill whatever the changes are.
Shadow health secretary John Healey said: "My fear is that we'll hear the prime minister claim these are substantial and significant changes, but the long-term ideological plan to turn the NHS into a market, to open up all parts of the NHS to private companies, will remain."
Nonetheless, the BBC understands that ministers are hopeful the NHS Future Forum report and the government response will allow them to press ahead almost immediately with the programme.
Officials are working on the basis that amendments could be made to the bill within weeks, allowing the government to kick-start the parliamentary process before the summer
Do you work in the NHS? What is your reaction to the government's planned reforms? You can send us your views using the form below.
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The NHS Future Forum, which carried out a two-month consultation, called for the overhaul to happen more gradually.
The panel of experts also said it wanted to see a greater balance between competition and co-operation among NHS hospitals, charities and private firms.
Ministers are expected to respond to the recommendations on Tuesday.
They hope that by acting quickly they will be able to get their NHS reform programme back on track in weeks.
In April the government took the unprecedented move of halting the parliamentary progress of the Health and Social Care Bill underpinning the changes amid mounting criticism from academics, health unions and MPs.
GP power Ministers had originally wanted to hand GPs control of much of the NHS budget, while opening up the health service to greater competition.
But while GPs will remain in the driving seat, they should consult with other professionals.
Continue reading the main story “Start Quote
If the substantial changes we propose are accepted by government then I think the resulting framework will place the NHS in a strong position”
End Quote
Professor Steve Field
NHS Future Forum
To ensure this happens, clinical senates made up of a variety of different experts including hospital doctors and nurses should be created to oversee the new system, the forum's report said.
The drive to create greater competition - perhaps the most controversial element on the plans - also needs changing, the panel said.
Originally, the regulator was to have a primary duty to promote competition, but that should be "significantly diluted".
The duty to promote competition should be removed altogether with competition only used as a means to improve services, the panel said.
The regulator, Monitor, should also not be called an economic regulator to allow it to focus on ensuring patients have choice, and so collaboration and integration between providers is encouraged.
The report also said consortia should only take on their responsibilities when they were ready.
Originally a deadline of 2013 was set, but the panel said the national board should take charge in individual areas until they were ready.
Professor Steve Field, the former head of the Royal College of GPs who led the NHS Future Forum, said while the principle of putting doctors in charge was well supported, he had heard "genuine and deep seated concerns" from many.
Continue reading the main story Analysis
Were the original plans for the NHS in England evolution or revolution? Do the changes proposed by the independent review represent a tinkering around the edges or wholesale changes?
For both these questions you get different answers depending on who you ask. In all probability only time will tell.
Take the issue of competition, much will rest on how the regulator interprets the legislation.
The response of GPs who will be driving the new NHS will also be key.
Pilots are already up-and-running, but it is possible that the review that has taken place could take the wind out of their sails.
When Labour launched its foundation trust policy to create elite hospitals free from political control it was a controversial and, it seemed, radical move.
Seven years on, most agree they have not really lived up to the original expectations. As always, the scale of change will depend on the actions of people - the doctors, nurses and managers on the front-line.
"If the substantial changes we propose are accepted by government then I think the resulting framework will place the NHS in a strong position."
Dr Hamish Meldrum, chairman of British Medical Association, said the government's approach during the listening exercise had been "refreshing" but this needed to be maintained in the coming months.
He added: "The Future Forum's recommendations address many of the BMA's key concerns, to a greater or lesser extent. We are hopeful that our missing concerns, such as the excessive power of the NHS Commissioning Board over consortia and the so called quality premium will be addressed as more detail emerges.
"Obviously, the critical factor is now how the government responds."
Professor Chris Ham, chief executive of the King's Fund think tank, gave the report his backing.
"The government must now move quickly to endorse today's report, put an end to the disagreements that have dominated recent months and provide the direction and stability the NHS desperately needs to navigate the challenging times ahead."
Sir Richard Thompson, president of the Royal College of Physicians, said changes to Monitor's role would be a "step in the right direction".
"The Health and Social Care Bill must clearly state that the primary focus of regulation is promoting integration, collaboration and quality - not promoting competition."
But Dave Prentis, general secretary of Unison, said: "The forum's changes may airbrush some of the flaws, but no amount of fiddling around around the edges is good enough when the future of the NHS is at stake."
Government mood Despite the formal announcement by government not being made until Tuesday, Prime Minister David Cameron has already accepted concessions will be made.
Last week he set out a series of areas he was planning to give way on. These chime closely with what the NHS Future Forum has now proposed.
Health Secretary Andrew Lansley thanked the Future Forum and said: "The Forum has been an invaluable source of expert advice and I have said we must keep listening on the NHS to deliver a world class health service.
"The Forum's reports show clear support for a health service that puts patients at the heart of everything it does, and where services are joined-up, accountable and focus on delivering better results for patients."
However, if the recommendations are accepted it remains to be seen whether that will be enough to satisfy all the competing interests.
The British Medical Association and other leading unions had wanted to see the role of competition downgraded much more.
While those who had been more positive about the plans had cautioned against making too many concessions which could, they have warned, compromise the ability of the NHS to cope with the twin challenge of rising demands and tightening budgets.
The political fall-out within the coalition is also being closely scrutinised.
On Monday Deputy Prime Minister Nick Clegg is expected to claim the Lib Dems have got their way in coalition battles over the bill when he meets his parliamentary party.
But backbench Tories have being vocal in expressing concerns the reforms are being watered down too much.
Labour has indicated it will be voting against the bill whatever the changes are.
Shadow health secretary John Healey said: "My fear is that we'll hear the prime minister claim these are substantial and significant changes, but the long-term ideological plan to turn the NHS into a market, to open up all parts of the NHS to private companies, will remain."
Nonetheless, the BBC understands that ministers are hopeful the NHS Future Forum report and the government response will allow them to press ahead almost immediately with the programme.
Officials are working on the basis that amendments could be made to the bill within weeks, allowing the government to kick-start the parliamentary process before the summer
Do you work in the NHS? What is your reaction to the government's planned reforms? You can send us your views using the form below.
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