The Government has lost the first vote on the Health and Social Care Bill after the legislation returned to the House of Lords.

Peers backed an amendment that mental health is made a higher priority under the reforms by a margin of just four votes.

Earlier in the day, during Prime Minister’s questions, Labour leader Ed Milliband called the Bill a “complete disaster”.

Other amendments on the powers and responsibilities of the health secretary were also discussed by peers – although none were voted on. But peers did accept a Government-backed amendment specifying that the health secretary retains “ministerial responsibility to Parliament for the provision of the health service in England”.

Cross bench peers also raised additional amendments to those proposed recently by the Government which are to be discussed in coming weeks.

Ana Nicholls, Healthcare Analyst at the Economist Intelligence Unit says the defeat is not a major blow to the Government. “This appears to [be] only a preliminary setback for the reforms, with the main debate over competition in the NHS not expected until March,” she said.

“Still, it adds to the pressure on the Government over the reforms, following as it does on the back of several medical bodies made their opposition clear. Clearly there will be a rough few weeks ahead. Nevertheless, it will be difficult at this stage to call a halt to the reforms, given that the reorganisation already taking place amid the primary care trusts and strategic health authorities.”

The Faculty of Public Health became the latest healthcare body to call for the withdrawal of the Bill – hours after the Institute of Healthcare Management made a similar unprecedented call.

Inconsistent NHS leadership questioned

The NHS has suffered due to inconsistent leadership over a prolonged period, peers in the House of Lords have been told.

Baroness Cumberlege, a Conservative peer, told the House the number of different health secretaries in recent times has led to a lack of trust and confusion by the health service.

Speaking during the committee stage of the Health Bill, Baroness Cumberlege compared the Sir Alex Ferguson’s 25-year reign at Manchester United and asked “what difference it might make to the NHS” had it had a leader for a similar tenure.

Since 1997, there have been seven different health secretaries – six of which under the previous Labour government.

“One of the real problems that we have, and it exists even if it is the same party in power for a length of time, we lack a consistency of leadership, because the Secretaries of State are here one minute and gone the next,” said Baroness Cumberlege.

“I think that contributes to an NHS that gets confused, that gets fed up and is mistrustful of its masters.”

Several Liberal Democrat peers are supporting a number of amendments to the Health Bill focused on the regulation of competition within the NHS.

Several senior Lib Dem peers support the amendments and could force the Government to change aspects of the controversial legislation following concerns the Bill could still extend the application of European competition law to the NHS.

Lord Clement-Jones, a former Lords health spokesman who backs the changes, says the amendments would “balance the competitive powers and the integrating duties”.

More than a dozen amendments have been tabled by Lib Dem peers. They include the constraint of Monitor’s action against anti-competitive behaviour, that private income generated by Foundation Trusts would be used solely for the benefits of NHS patients, and that public interest be considered when the Office of Fair Trading is consider mergers.

Speaking to the HSJ, Lord Clement-Jones said he and his colleagues aimed to “make sure we didn’t fall into having a health service covered by European competition law” and that “we don’t have competition red in tooth and claw across the health service”.

The consideration of the Bill at the committee stage in the House of Lords is set to continue until the New Year.

The BMA has set out eleven areas of continuing concern with the Health and Social Care Bill.

The Association says that a series of further amendments to the Bill are necessary in “order to mitigate damage” to the NHS.

Its recommendations include giving Clinical Commissioning Groups (CCGs) the freedom to commission the most appropriate services, and ensuring the Secretary of State retains ultimate responsibility for the NHS.

Dr Hamish Meldrum, BMA Chairman, says although the Association would prefer the Bill to be withdrawn, “there is scope for further significant change to be made” during its passage through the House of Lords.

In its latest briefing paper, the BMA also calls for an amendment which makes it explicit that patient choice will not be given priority over fair access for all. It also wants further safeguards which prevent providers of care or services ‘cherry-picking’ more profitable services.

On incentives for commissioning, the Association “continues to have serious concerns” about conflicts of interest with the link of financial incentives to the performance of CCGs.

Dr Meldrum hopes that peers in Lords will agree with the suggested amendments and change the controversial legislation before it progresses any further.

“Because so much of the detail won’t appear on the face of the Bill and will instead be left to secondary legislation and guidance, it is essential to have firm assurances now about the government’s implementation plans, for example, we continue to have serious concerns about the ethics of the current proposal to incentivise commissioners,” he said.

“Other areas where the BMA is seeking amendments relate to public health; the private patient income cap; the foundation trust failure regime; increasing bureaucracy and complexity, and information and confidentiality.”

Members of the BMA have previously expressed “major concerns” about the Health Bill on various occasions, calling for the Government to amend the plans back in June 2011.

The Health and Social Care Bill is set to continue its progress after the Government won two key votes in the House of Lords.

Peers voted 330 to 262 against an amendment to refer parts of the Bill to a special select committee and also rejected an amendment to block the legislation altogether.

Ministers say that the votes show the Bill now has wide spread support but the BMA has again called for it to be “withdrawn” or “substantially amended”.

A line by line examination of the Government’s controversial reforms will now begin in the House of Lords on 25 October. Labour has said it will again “fight” the proposals despite the outcome of the votes.

The amendment to block the Bill was put forward by Labour peer and former GP Lord Rea, who argued that it was never a manifesto by either the Conservatives or the Liberal Democrats. It was rejected 354 votes to 220.

Attempts to delay the progress of the Bill, which Lord Howe said my “prove fatal” to the NHS, were tabled by two crossbench peers, Lords Owen and Hennessy. The two called for its referral to a special select committee, which would have allowed witnesses and experts to provide evidence on the proposals after concerns were raised about the responsibility of the health secretary and the role of the NHS’ regulator Monitor in promoting competition.

A spokesman for the DH says decision by Lords “moves us one step closer to delivering a world-class health service that puts patients at its heart and hands more power to health professionals”.

But Andy Burnham, Labour’s recently appointed Shadow Health Secretary, says hearts “sunk around the NHS” when the Bill survived the votes and the Government is “digging in for the long haul” as it faces more opposition.

Doctors’ leader Dr Hamish Meldrum, Chairman of the BMA, says it continues to have concerns about “many areas” of the Bill and says the council will continue to raise its opposition “at every available opportunity”.

Dr Meldrum called for an assurance that patients’ choice of provider of care would not be given priority over the development of integrated services and fair access.

“We also need to see an explicit provision that the Secretary of State will retain ultimate responsibility for the provision of comprehensive health services. In addition, we continue to have significant concerns over the arrangements for public health and education and training and we will be looking to see improvements made in these areas too.”

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