Landmark reforms to the NHS in England will finally become law after being granted Royal Assent by the Queen.
The event, which marks the final step for approval of new law in the UK, came the same day that a draft risk register describing problems with the Health and Social Care Bill was leaked to healthcare commentator Roy Lilley.
The document is dated September 28, 2010, four months before the first draft of the Bill was published, and outlines criticisms still expressed today by the Bill’s many opponents despite over 1,000 subsequent amendments to the reforms.
The risk register includes worries over the danger of setting up a new system too quickly, the loss of budgetary control, whether a devolved system can cope with emergencies and the role of private sector organisations/staff within the NHS.
Attempts to force the coalition Conservative/Liberal Democrat government to publish the final risk register from November 2010 had been a last-ditch effort from Labour to postpone the passing of the Bill. However, this request was voted down by MPs in parliament.
The publication of the draft version of the register comes too late to affect the course of the Bill though, with the Queen’s approval confirming its passage into law after 14 months in parliament.
Changes to the NHS in England have already been implemented across the country, including the setting up of GP-led clinical commissioning groups (CCGs), which would see GPs take over commissioning duties from the current primary care trusts and strategic health authorities.
According to the Department of Health, 266 CCGs have already been formed, covering almost the entire population of England.
These groups now need to undergo an authorisation process to ensure that they will be both financially stable and cover an appropriately sized region.
Health Secretary Andrew Lansley, the architect of the Bill, has faced criticism from many groups for his handling of the reforms.
Commenting on the Royal Assent he said: “The Health and Social Care Act will deliver more power to clinicians, it will put patients at the heart of the NHS, and it will reduce the costs of bureaucracy.
“We now have an opportunity to secure clinical leadership to deliver improving quality and outcomes; better results for patients is our objective.”
The issue of ‘bureaucracy’ might not be solved by the reforms, however, according to Mike Farrar, chief executive of the NHS Confederation, which represents managers.
He said: “Ministers have shamefully undervalued managers and put an axe to the resources needed to manage the service properly, yet they then create a system that potentially introduces more and more bureaucracy.
“New organisations and processes set up by the Bill need to serve patients interests but they must be careful to add value, particularly when pressure on resources is so severe.”
One of these processes sees Monitor, which regulates Foundation Trusts, given increased powers to act as a more general economic regulator and promoter of competition.
On Monitor, Farrar said: “We are convinced that a specialist sector regulator can be right for the NHS in theory, but the jury is out on whether it will be so in practice.
“Monitor needs to nip in the bud serious concern that the potential benefits will not materialise and that the costs will be disproportionate. It has to add value and not detract from it.”