Over at The Guardian, Baroness Shirley Williams has a piece setting out the problems she has with the government’s proposed NHS reforms, and four substantive changes that the Liberal Democrats would like to see made.

Here’s a sample:

First, the role of the secretary of state: as the excellent fifth report of the House of Commons health committee pointed out, the public, who pay for the NHS, look to the secretary of state to be responsible for the delivery of a comprehensive health service, one that is equitable, accessible to all, and free at the time of use. The National Commissioning Board will be accountable to the secretary of state; Monitor, the central regulatory agency that will license any new providers, should be accountable to him too, and should promote competition only on the basis of quality. Its main responsibility should be to promote integrated working and partnership between primary and secondary care and local authorities. The commissioning authorities should determine the shape of service provision, and should be able to commission services from a qualified provider if – and only if – that will complement the overall service provided.

Second, the original proposal for local commissioning bodies to be composed entirely of GPs has been heavily criticised. The Commons health committee, the Royal College of Physicians and the British Medical Association all suggest that the new consortiums should include specialist clinicians. There should also be representatives of other medical professions like nursing, of the local community and one or more independent members, including the chair. The consortiums should have a board, a chief executive and an identified finance director.

Third, openness: there is growing agreement that the local commissioning bodies must meet in public and keep records of their meetings that are open to public scrutiny. Members of commissioning bodies should register publicly any financial interest they may have. The current local authority scrutiny committees are valuable and should be retained.

Fourth, co-terminosity: as far as possible, NHS commissioning authorities should be co-terminous with local authority boundaries, to reduce complex bureaucracy, and to enable commissioners to co-operate with local authorities on social care, and with specialist networks for rare or chronic conditions. These networks are proving successful in improving quality while keeping down costs.

You can read the piece in full here.