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After the House of Lords voted against blocking the Health and Social Care Bill, which would put GPs in control of buying care, commentators ask why it is so controversial.

that the idea power will be devolved is a principle that just doesn't work for the NHS:

"The House of Lords might have voted for the NHS proposals yesterday afternoon, but the debate that preceded their tame verdict highlighted a single, forensically expressed concern. No one argued that the health service was a perfect model as it currently stood, or that it could not be much more efficient, but former health ministers, surgeons and the rest outlined their alarm that the new lines of accountability were dangerously unclear and that the envisaged responsibilities of the Health Secretary were extremely limited.
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"...Indeed that is the objective of the reforms, in theory a noble one, to take power away from the centre and, ultimately, to empower patients. But the theory is tested at every stage by practicalities, so much so that already a policy aimed at reducing the number of bureaucrats looks like increasing the mediating agencies with no one knowing who is in control. This has not happened by chance. No doubt the coalition seeks to save money, but the ideological dimension is absolutely clear, the centre cannot and should not be held responsible for the delivery of local services."

The the interesting thing about the campaign against the bill was that campaigners targeted lords after being frustrated by MPs:

"We should look at the defeat of the Owen-Hennessy amendment not as a failure but as the beginning of something - the beginning of a process in which Lords are lobbied directly; in which they take public opinion seriously but aren't so cravenly people-pleasing that their debates sound like EastEnders; in which the taint of being the unelected chamber is offset by the fact that nobody voted for the other lot's policies either; in which they might be pressurised by their party but a good proportion of them can withstand it."

how she intends to continue to campaign against the changes:

"So the Bill now goes to its committee stage, a time when a cascade of amendments will be tabled, each one argued to death and perhaps significant changes brought to this unwieldy and unwelcome bill. We face hard days ahead, but every inch gained will be worth it. We all know that the British public want the NHS to survive as they know it, only better."

The the "war of attrition" by Labour peers such as Baroness Bakewell is a depressing prospect as a report on the lack of care shown towards elderly patients puts into focus that reforms are needed:

"What the NHS now needs is clarity and certainty about its future. True, the Bill, heavily revised to accommodate Lib Dem objections, may well produce a more bureaucratic regime than currently exists - if the Lords can remove the measure's top-heavy structures, it would perform a valuable function as a revising chamber. But peers would be wrong to undermine the Bill's ambition to create a more effective and better-managed NHS."

Finally that the whole bill should be abandoned because there is nothing in it which requires legislation:

"Competition and GP commissioning were not invented by Andrew Lansley, the Health Secretary; they began under Labour. The most successful GP consortium I have visited, in Bexley, started in 2007. Competition was unleashed by Alan Milburn's 'any willing provider' policy in 2000. When the coalition took over, the NHS was spending £1 in every £20 on services from the private sector or charities. A private company was shortlisted to take over Hinchingbrooke NHS hospital in Cambridge before this Bill was even dreamt of.
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"You wouldn't know any of this from the current hysteria. By presenting these ideas as new and creating a Bill that needs parliamentary assent, Mr Lansley has given vested interests the perfect platform to complain about "a secret plan to break up the NHS". So all the old arguments about the internal market that were made about the Clarke reforms of 1990 and the Milburn reforms of 2000 are now being replayed unnecessarily, in stereo."