NHS: The shape of things to come

NHS worker

The health and social care bill has gone though more than a year of debate and more than 1,000 amendments in the Commons and the Lords. So what has changed?

What the coalition wanted:

* GPs to take responsibility for £60bn of NHS funds

* Competition to be extended to more NHS services

* Reduced bureaucracy and fewer managers

* An increased role for the private sector

* Backing from every professional group involved.

What they have had to compromise on:

* NHS professionals such as hospital consultants and nurses given greater say in spending

* Competition limited to quality not price

* More managers to look into perceived risks

* All providers to be assessed for their suitability to run services.

The shape of things to come:

* Clinical commissioning groups (CCGs) replace primary care trusts

* CCGs decide on care for patients, advise them where to go for treatment and pay the bills

*Some of the day-to-day control of the NHS passes to the new NHS Commissioning Board, which will manage the CCGs at a national and local level

*Responsibility for public health issues like obesity, smoking and alcohol abuse is handed to local councils

*All hospitals become foundation trusts and compete for treatment contracts from CCGs

*The cap on how much hospitals can earn from private patients rises from as little as 1.5% to 49%.

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