Parliamentary briefing
19 Mar 2012

After substantial revision, the Health and Social Care Bill is returning to the House of Commons. This briefing examines the Lords amendments as MPs prepare to discuss the primary legislation.


The Bill that returns to the Commons is quite different from the one that MPs debated last year. Building on the considerable changes voted in by MPs following the NHS listening exercise, the Lords amendments emphasise an alternative vision of public sector reform.

There is now a stronger emphasis on statutory structures to deliver accountability for public funds and an emphasis on collaboration and integration alongside competition

Building on the considerable changes voted in by MPs at report stage, the Lords amendments offer an alternative vision of public sector reform

This briefing focuses on several of the major amendments relating to ministerial responsibility for the NHS, economic regulation and clinical commissioning group (CCG) conflicts of interest. Ahead of the Bill becoming law it focuses on questions of implementation.

The briefing makes a number of observations, including that:

  • The challenge of reducing Whitehall’s attempts to control the NHS in the future will be as much cultural as legal;

  • The forthcoming review of the Constitution will need to strike the right balance between providing a robust national framework of service assurances and respecting local commissioners’ freedom to act;

  • Much of the behaviour of providers will in practice be shaped by detailed guidance and the work on pricing conducted by both Monitor and NHS England (formally the NHS Commissioning Board). The two organisations have a major task ahead of them to ensure there is the necessary information, data exchange, contracting and payment tools to support patient choice, integrated care, efficiency and quality;

  • The extension of Monitor’s scrutiny powers over foundation trusts have the potential to reinforce the tendency in the NHS for boards to look ‘upwards’ continually to their regulators, at the expense of thinking creatively about how to best meet the needs of their communities. Monitor will need to adopt a sufficiently nuanced approach to discourage this;

  • The greater emphasis on robust governance must not generate unintended consequences such as an unwarranted use of tendering, which could be costly and time consuming. Commissioners need to be properly supported by clear, official guidance on how to manage procurement in a proportionate way.

The paper is the latest in a sequence of the Nuffield Trust’s policy briefings that analyse the main areas of controversy surrounding the Bill and which suggest several measures for their resolution.

Our experts continue to examine NHS reform in detail, both in terms of the Bill as well as more widely. For details of our current projects, as well as links to the relevant publications and blogs, video interviews, slideshows and press releases, visit the dedicated area of work page on NHS reform.

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