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The Health and Social Care Bill: Peer’s improvements and GP co-operation

On 12th March, the day we met with him, Lord Walton of Detchant, had the following letter published in The Times. He almost seems to pre-empt today’s announcements by the Royal College of General Practitioners, which have the tone of reluctant acceptance. 

Lord Walton is looking on the bright side. He wishes it “had never been introduced” but obviously feels that peers have tamed a wild beast into something less ferrel. 

Now the RCGPs seem ready to roll up their sleaves for the task of implementation, rather than amendment. They still call for the withdrawal of the Bill, only they now feel that it is the time to work with the Government.

“It is right and logical that the College invites the Government to work with us to ensure that the NHS is fit for purpose, stable and safe for the patients who use it, now and in the future.”

However one feels about the Bill, it is coming. Despite the denial, anger, bargaining and depression of many since it was introduced in 2010, even those who have been in (varying degrees) of opposition have finally reached acceptance. Just as we have had the sixth sitting of the Lords report stage, many seem to have experienced the five stages of Health and Social Care grief. 

Now we are at the fifth stage, acceptance, Lord Walton is looking on the bright side. He is concentrating on what he sees as the vast improvement generated by the Lords’ chamber.  The Royal College of GPs are realising that “whatever happens, it will be our 34,000 GP members who live and work in England who will be expected to make things work to the benefit of our patients.”

Whether you see this as a victory, an inevitability or a coping mechanism, everyone seems to be bracing themselves for its assent. We have to prepare for life after the Bill. 

Wise and constructive proposals by peers have led to many vital amendments, which have made the new bill more palatable


Having graduated in medicine before the NHS began, I have lived through innumerable reorganisations, major and minor. Some have been helpful, many much less so, and many totally misconceived. Specifically, the massive 1974 reorganisation under a former Conservative  Government was disastrous and took three painful years to overturn. I therefore studied anxiously the original Health and Social Care Bill now making its way through the Upper House, and was deeply disturbed by what struck me as being an unnecessary, unacceptable and potentially destructive measure.

Like many doctors, I wish it had never been introduced, so I am not surprised that clamorous voices from the BMA, the Royal Colleges, nursing organisations and many more bodies have demanded that it be abandoned. Through repeated operation of the more bodies have demanded that it be abandoned. Through repeated operation of the Parliamentary guillotine, the Bill emerged from the House of Commons virtually unamended. Since it reached the House of Lords, innumerable meetings, seminars and briefings have been held, while lengthy debates in committee, and more recently in the report stage, have regularly continued late into the night, with amendments being closely debated.

I and my medical colleagues, with peers of all parties including independent crossbenchers like me, have participated fully in this lengthy process. To those organisations still demanding that the Bill be dropped, I must say, in the light of Government resistance, at this late stage, that that is wholly improbable. Happily, following wise and constructive proposals by many peers, the Government has accepted many vital amendments, which have done much to modify or even overturn some of the worst features of the Bill. I must pay a very warm tribute to the remarkable cooperation we have enjoyed our Health Minister, Earl Howe, and the Bill team, who have now enabled the House to improve the Bill beyond measure. While I would still have preferred if it had never been tabled, I now believe that when the Bill completes its stages in the Lords, by the end of March, it will be much more acceptable and manageable. As the end of this marathon is in sight, I cannot but speculate with deep apprehension as to what fate the Bill would have suffered if, on emerging from the Commons in the form that it did, it had then been considered by a politically dominated and elected Upper Chamber.


Lord Walton Of Detchant

Former president, BMA, General Medical Council, Royal Society of Medicine,

Association of British Neurologists, World Federation of Neurology,

House of Lords