Peers voted 330 to 262 against an amendment tabled by Lords Owen and Hennessey which would have referred parts of the bill to a special select committee.

Proposals to end the Bill completely were defeated by 354 votes to 220.

Commenting on the developments, Dr Hamish Meldrum, Chairman of BMA Council, said: “It remains the BMA position that the Health and Social Care Bill should be withdrawn, or if not that it should be substantially amended, and we will continue to raise our concerns at every available opportunity as the Bill progresses through the House of Lords.

“The BMA continues to have many areas of concern, including the need for assurance that increasing patients’ choice of provider for specific elements of their care won’t 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.”

A Department of Health spokesperson said: “The vote today 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. We now look forward to working with the Lords to scrutinise the Bill during Committee Stage to improve our plans further.”

Last week almost 400 health professionals and academics wrote to peers asking them to vote against the bill, arguing it would do “irreparable harm to the NHS, to individual patients, and to society as a whole.”

Described as the biggest shake-up of the NHS since its creation, the controversial plans – which would increase competition and give clinicians control of budgets – have already been substantially altered following criticism from NHS staff and Liberal Democrat MPs.

Responding to the Department of Health’s Preventing Suicide in England: a cross-government outcomes strategy to save lives document, Unite has drawn parallels with the Greek economic meltdown which has reported a 40% rise in suicides in the first half of this year, compared with the same period in 2010.

Unite, which embraces the Mental Health Nurses Association, acknowledges the Department of Health’s development of a new suicide prevention strategy for England with the aims of reducing suicide rates and improving the support for those bereaved or affected by suicide.

Unite professional officer Dave Munday said: “We believe that the economic crisis engulfing the country will increase the pressures on individuals, faced with tightening finances, repossessed homes, marital breakdown and lost jobs.

“Bearing in mind that 20% of the population will suffer mental problems during their lifetime, this cost-cutting government should not sweep mental health under the carpet because society deems it as an uncomfortable subject.”

A survey carried out on behalf of the Department of Health shows that this new freedom is what patients are looking for:
• 84.80 per cent of respondents want more choice in where they are treated in the NHS
• 81.93 per cent of respondents want more choice in how they are treated in the NHS
• 53.18 per cent of respondents were not aware that they can choose which hospital to go to for non-emergency treatment
• 77.41 per cent of respondents wanted a choice over which hospital consultant is in charge of their care
• 78.23 per cent of respondents wanted a choice over which hospital consultant is in charge over their children’s care.

As part of the Government’s plans to modernise the NHS and improve patient choice, new guidance sets out how all NHS providers of care will have to accept all clinically appropriate referrals to named hospital consultant-led teams.

In addition, NHS providers will have to publish relevant information about their consultants and the services they provide, ensuring greater transparency in the NHS and enabling patients to make informed choices about their care.

There will be no geographical boundaries imposed on referrals. Patients will be entirely free to choose the consultant team best placed to meet their individual needs and deliver the best possible results for them.
Some patients may choose a named consultant-led team which has the most experience of a particular condition or treatment on the advice of their GP; others may choose to be treated by the consultant who has treated them successfully in the past.

Andrew Lansley said: “This marks yet another step towards modernising the NHS and giving patients a greater say in their healthcare. To date, patient choice in the NHS has been very limited, but that’s all about to change. From April next year, patients will be able to choose not only where, but who provides their care.
“But this will only work if patients can access relevant information about NHS consultants and the services they provide. That’s why all NHS providers will be required to publish this vital information and support real patient choice.

“We know that transparency can drive up standards of care and improve services for patients and that’s what this is all about – providing real choices for people over their care, leading to better results.”

Services currently excluded from choice of consultant-led team are: accident and emergency services; cancer services, which are subject to the two week maximum waiting time; maternity services; mental health services; and any other services where it is necessary to provide urgent care.

The Government’s response to the Choice of named consultant-led team consultation and the guidance to the NHS on how to implement choice of consultant-led team can be found here: http://www.dh.gov.uk/health/category/publications/consultations/consultation-responses/

Just over twenty thousand people (20,038) were subject to the Act in England on March 31 2011; a rise of 991 since March 31 2010 according to today’s report, which looks at those formally detained in hospital or supervised with a community treatment order (CTO).

The figures suggest that this is due to a larger number of people being supervised under community treatment orders, according to: In-patients formally detained in hospitals under the Mental Health Act 1983 and patients subject to supervised community treatment, Annual figures, England, 2010/11.

At 31 March 2011, 4,291 people were subject to a CTO; almost thirty per cent higher than at March 31 2010 (3,325).

For two consecutive years, the number of new CTOs was greater than the number ended during the year and this suggests that some people remain on a CTO for more than a year.

The report also shows that formal admissions to hospital fell slightly compared to the previous year. In 2010/11, there were 30,092 formal admissions, a 2.2 per cent decrease compared to 2009/10 (30,774). The report suggests this slight reduction could be linked to the use of CTOs.

NHS Information Centre Chief Executive Tim Straughan said: “Today’s report suggests that community treatment orders have been used on a significant scale since their introduction in 2008, to care for people with mental health issues outside of a hospital environment.

“This information is important in monitoring the use of the Mental Health Act in this country, and I am pleased to say that we hope to further increase the depth of information available on this important subject in future reports. This is due to a change of data source, as proposed following the Secretary of State’s Fundamental Review of Data Returns.

“A consultation on changes to the report is planned to be open for three months from early January 2012 and I would encourage people to take part; helping ensure we can make future reports even more useful and answer the broader and more detailed questions around the use of the Mental Health Act.”

The report can be viewed at: www.ic.nhs.uk/pubs/inpatientdetmha1011

The consultation is planned to be open from early January 2012 at: http://www.ic.nhs.uk/work-with-us/consultations

The SCR is a secure, electronic patient record which is currently being introduced in England. Last October’s review, commissioned by Health Minister Simon Burns, restricted the record to carrying basic information about medications, allergies and bad reactions to drugs. So for example, patients with asthma would no longer need to be asked to repeat their medical history while struggling to breathe. Patients can however speak to their GP about adding extra information they may want the NHS to know about them in an emergency to their SCR.

To date, 8.8 million SCRs have been created and 33.5 million patients written to. There are twelve areas in England where over half of the patient population has a record.  The current recorded opt out rate is 1.24 per cent.

The main issue identified by patient groups which the SCR could help remedy is patients having difficulties communicating their needs; whether it is a nurse not knowing how to tell if a patient with learning disabilities and limited verbal skills is in pain to ensuring a doctor unfamiliar with neuromuscular conditions does not deliver inappropriate treatment that could leave a patient permanently needing to use a wheelchair.

Following the Ministerial review, patients can easily decline having a SCR by using the opt-out form and freepost envelope included in letters being sent to patients or by consulting their GP. As an added safeguard, patients will always be asked their permission before their SCR is viewed.
Health Minister Simon Burns said: “I am delighted that, a year on from our review, patients and groups representing them are seizing the initiative in exploring how the Summary Care Record can best meet their needs. They have given us valuable insights into just how crucial it is that clinicians have the right information at the right time to deliver the safest, most effective care.”

Over a million patient safety incidents are reported every year, so the Government will set out proposals that will require NHS providers to be more open and admit when things go wrong.

The new ‘Duty of Candour’ consultation will form part of the Government’s plans to modernise the NHS by making it more accountable and transparent and giving patients and local clinicians more power to hold the NHS to account. This was also signalled in the Government’s response to the independent Future Forum in June 2011.

The contractual Duty of Candour in Healthcare will be an enforceable duty on providers to be open and honest with patients or their families when things go wrong ensuring they receive information about any investigations and encouraging the NHS to learn lessons.

Being open with patients when something goes wrong is a key component of developing a safety culture; a culture where all incidents are reported, discussed, investigated and learned from.

In particular, the consultation will ask stakeholders the best way of enforcing such a contractual duty and asks some key questions on the following areas: what exactly should the Duty require the NHS to do?; what should the penalties be for breaching the duty?; should organisations have to make an annual ‘declaration of openness’?; and what support do patients and clinicians feel would help them act when they feel the NHS is not being open about an incident?

Health Secretary Andrew Lansley said: “We must develop a culture of openness in the NHS. This is a key part of how a modern NHS should be – open and accountable to the public and patients to drive improvements in care.

“That’s why we are introducing a requirement on providers to be transparent in admitting mistakes. We need to find the most effective way to promote openness and hold those organisations that are not open to account.

“A more transparent NHS is a safer NHS where patients can be confident of receiving high quality care.”

Dr Landy, who works as an associate speciality doctor at Craigavon Hospital, said: “I am delighted to have been elected by my colleagues to this position, having been involved with this committee for many years.

“Many SAS doctors are leading services in hospitals and communities across Northern Ireland and I believe it is essential that we work cohesively to raise the profile of this essential group of doctors.

“We must work to ensure continuity of patient care in a range of areas; however morale is being affected by challenges to contracts, pensions and working conditions.

“There are currently around 400 SAS doctors in Northern Ireland and this number is set to increase. Colleagues and I will be working to ensure that becoming a SAS doctor is an attractive career option, with the possibility to develop and acquire skills within the grade.

“This will lead to greater sense of job satisfaction and fulfilment, better staff retention and also improve contribution to patient care”

In a speech at the United Nations, Mr Lansley said that real progress against cancer, respiratory disease, cardiovascular disease and diabetes can only be made through collective international action to curb tobacco consumption and reduce alcohol abuse.

He said: “More than half a century ago, our predecessors came together to tackle infectious diseases: the greatest health challenges of their day. Today, we face new challenges from obesity, lung disease and alcohol-related diseases. These are inextricably linked to the way we live our lives. They are just as widespread, just as chronic and increasingly threaten early mortality and disability.

“We need a bold and determined ‘whole government’ approach looking at better outcomes and helping individuals to make better choices about their own health. With an emphasis on prevention, on physical activity, on personal and corporate responsibility and with unified government action, we can make a big difference.

“I hope that in decades to come, our successors will look back and see that now was when the tide began to turn, that with progress and development, came not only opportunity and increased life expectancy, but healthy life expectancy.”

The latest seasonal flu vaccine uptake reports show, for the first time, those healthcare workers by occupation who accepted the scientific advice and who chose to protect themselves against flu last winter. Uptake was revealed as:

• 30 per cent of nurses, including hospital nurses and midwives
• 42.5 per cent of GP practice nurses
• 38.2 per cent of GPs
• 37 per cent of doctors excluding GPs

The number of healthcare workers getting the vaccine had increased from 26.4 per cent in the 2009 winter to 34.7 per cent in 2010. However the majority of nurses who work with the most critically ill over the winter months and midwives who work with pregnant women, were left vulnerable to flu, its potentially life threatening complications and passing it onto patients and family.

Chief Medical Officer Dame Sally Davies added: “NHS staff face increased pressure over winter, especially if there is a severe flu season. They keep the NHS running and it is vital that they protect themselves, their patients and families from the potentially serious effects of flu that they are exposed to over the winter period.

“It is never too early to start thinking about flu. So as NHS staff return from their holidays, I urge them to plan ahead and get vaccinated.”

Public Health Minister Anne Milton added: “I urge all of our dedicated nurses, especially those who work with the sickest patients and midwives working with pregnant women, to protect themselves and their patients from flu. I hope these figures will provide a reminder for all healthcare professionals to start thinking about flu now and plan when they will get vaccinated this year.”

Former banker Lord Howe told an audience of private sector providers that though the NHS “will not give up their patients easily”, there were opportunities for those wishing to ‘enter the fray’.

He said: “The opening up of the NHS creates genuine opportunities for those of you who can offer high quality, convenient services that compete favourably with current NHS care. If you can do that then you can do well.

“But you know that won’t be easy, the NHS isn’t a place to earn a fast buck and as I said there are some outstanding performers in the NHS and they will not give up their patients easily, but I know that those who are serious about entering the fray are also determined to rise to the challenge, to deliver excellent care, to stand on your own merits against the best the public sector has to offer to bring new levels of choice and quality to patients.”

Responding to Earl Howe’s comments, John Healey MP, Labour’s Shadow Health Secretary, said: “Time and time again, David Cameron has tried to claim that his reckless reorganisation is not about privatising the NHS – but now his own health minister has exposed the true purpose of the Tories NHS plans, saying that the reorganisation presents ‘huge opportunities’ for the private sector.

“This confirms what doctors, nurses, health professionals, patients’ groups and Labour have all warned – the Tories’ NHS plans will fragment our health service by placing competition ahead of patient care.

“David Cameron is undermining the NHS with an incompetent and bureaucratic reorganisation which puts profit before patients.”