Plenty more fun to come as peers work on the NHS Bill

Even while yesterday's armistice remains in force, (see previous post) there's plenty more fun to come in the Lords on the Health and Social Care Bill. Wednesday's decision not to force a vote on Baroness Shirley Williams' amendment on the powers of the health secretary has kept the issue in play - with the aim of forging a compromise in behind-the-scenes negotiations.

Many peers are worried about a lack of accountability for £120bn of public spending, and others harbour deep suspicions that the real government agenda is back-door privatisation. Whatever the reason there is now a considerable head of steam behind finding a compromise, and the government clearly calculates that it will not be able to keep its current wording intact - which was why it was prepared to support Lord Mackay's attempt at a compromise wording.

But that's only the beginning of the challenges facing the government. I gather that many peers were less than ecstatic about the responses they received during discussion of mental health yesterday, and more amendments are promised on that issue. Next Wednesday's committee session is supposed to deal with the "autonomy" granted to commissioning bodies under the bill - but this is seen as indivisible from the powers of the health secretary, on the basis that it is him they would be autonomous from... So expect a short debate on principles rather than actual amendments, with all kinds of markers being put down for those continuing negotiations.

Then there are questions about integration of services, of transparency in a system with numerous purchasers and providers, and about keeping confidential patient records, er, confidential. There are peers who want a detailed register of interest for those involved in NHS commissioning decisions, and stiff penalties, including striking off GPs who take part in decisions which have a direct effect on their financial interests. Other peers want more robust arrangements around public health, with requirements that public health officials are properly qualified and cannot be sacked simply for being inconvenient - some peers want the health secretary to have to approve the dismissal of officials in key public health posts.

The list goes on - how about an explicit Whistleblower's Charter, so that the often-quite-junior staff who expose mistreatment of patients or people in social care are protected from retribution?

The "usual channels" in the Lords (the party and crossbench business managers) have now shaken hands on a deal which gives peers 14 committee stage days to debate all this - which implies two days every week until Christmas, and then a seven-day report stage, starting in the New Year, at which that compromise on the powers of the health secretary will be unveiled. 14 days is a lot of prime debating time - but senior people in the Lords believe more days will be needed and the committee stage will drag on into 2012.

And with the effective deadline for completing the current crop of legislation March 28th - the bill will come perilously close to the point where the government will have to start making big concessions or face losing it altogether, which is what happens when bills don't pass both Houses of Parliament before the end of the session. (It's probably not possible to carry it forward into the next session.)

There may also be collateral damage to other bills - the mammoth Legal Aid, Sentencing and Punishment of Offenders Bill, which has only just cleared the Commons, could be squeezed for time. And that's just for starters. We'll know government business managers are worried if they scrap the normal late-February half-term break, beloved of skiing peers.

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