House of Lords hears how injured troops could lose out under NHS reforms, as government accepts amendment on aftercare
Severely wounded soldiers returning from Afghanistan could miss out on the essential care they need under controversial NHS reforms, the House of Lordshas been warned.
Putting more emphasis on treating patients with rare and complex conditions such as multiple battle injuries, severe anorexia or severe head injury was one of several amendments put forward by lords debating the heath and social care bill.
The government accepted a crossbench amendment intended to prevent the health bill opening the door to charging for the aftercare of mental health patients. There were fears that by removing the duty of primary care trusts and local authority social services to work together to jointly provide free aftercare, such as day care places and supported accommodation, the bill would mean the new clinical commissioning groups would only provide health services under the NHS Act 2006, which includes provision for charging for aftercare.
Lord Patel, who moved the amendment, said that ministers did not understand "the full import" of what the bill proposed. But health minister Lady Northover said the government did not want to do anything that would bring in charges for any NHS services currently provided free under the Mental Health Act. The government would not oppose the amendment, and would incorporate Patel's proposals at third reading, she said. "We did indeed hear what he … was saying," she said.
Labour peer Lord Hunt of Kings Heath also moved a change to the legislation that would force the new GP clinical commissioning groups to be put in charge of managing patients' care to have an independently appointed chair and non-executive board members. They would be able to address concerns that the commissioning groups could take financial advantage from decisions by putting profits before expensive drugs or operations.
Crossbencher Lady Finlay of Llandaff, a former GP and president of the Royal Society of Medicine, said the government's health and social care bill did not place enough emphasis on treating those with rare and complex conditions, and asked for an amendment to force the government to put as much emphasis on treating patients with such conditions as those with more common complaints.
Some injured troops already have to raise their own funding to travel to the US where they can be be fitted with the most advanced prosthetics, Finlay told peers.
Earlier, the Liberal Democrat peer Lady Williams said homeless people and travellers could be deprived of treatment under the bill. She said many patients who move around the country could fall off the radar of the new GP consortia, which are replacing primary care trusts under the reforms.
"It is very important because the people who tend to be left out tend to be the most vulnerable," said Lady Williams. "The crucial point of principle here is that we are not only talking about only emergency care as a last resort. We are talking about all services that clinical commissioning groups provide and that should govern all residents of England."
Finlay and Williams withdrew their amendments after health minister Lord Howe said he accepted the "fundamental importance of ensuring the provision of services for patients with less common conditions", but he insisted it was "already covered by the bill's provisions".
Hunt said: "If you give enormous power to professionals who can financially take advantage from their decisions you do need very strong corporate governance safeguard," and moved to a vote, which he lost by 282 votes to 185, a government majority of 97.
Howe accused him of adopting a "gloomy outlook" as he had not taken account of "the arrangements already in place".
Earlier in the day prime minister David Cameron and Labour leader Ed Miliband clashed again over health at prime minister's questions – the fourth week in a row the topic has dominated the weekly event.
Miliband said the Conservatives were "digging their own burial at the next general election" by pushing on with Andrew Lansley's controversial health reforms, as the Labour leader roll-called the tally of organisations calling for the legislation to be scrapped.
The prime minister hit back as he insisted there was support for the role of competition in the NHS and played down opposition to the government's beleaguered health reforms.
Cameron told MPs: "The problem for the Labour party is they are against both the money that needs to go into the NHS, which they say is irresponsible, and although they supported competition and choice in the past they don't support it any more."
The prime minister also challenged the scale of opposition to the bill by rank-and-file members within professional bodies that have attacked the reforms. "There are 44,000 members of the Royal College of GPs. Out of a total of 44,000, just 7% responded opposing the bill," he said.
Miliband challenged the premier to list organisations that remain "wholehearted supporters" of the reforms. He cited the former NHS chief executive Lord Crisp, who recently described the bill as "a mess" and "unnecessary" and said it was "setting the NHS back".
He also raised the opposition of the Tower Hamlets clinical commissioning group to the bill and the bureaucracy it generated. "Isn't it time you recognised you have lost the confidence even of the GPs you say want to be at the heart of your reform?" he said.
Listing the growing number of organisations to call for the bill to be withdrawn, Miliband said: "With every week that goes by, there are yet more damning indictments of your NHS bill."
He added: "Does it not ever occur to him that just maybe they're right and he's wrong?"