NHS structure changes come into force

Doctor's equipment, a sphygmomanometer and stethoscope The changes have proved extremely controversial

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Government reforms of the NHS in England have come into force and health leaders warn of a tough year ahead.

Monday marks the first day of the new structures.

GP-led groups have taken control of local budgets and a new board, NHS England, has started overseeing the day-to-day running of services.

The NHS Confederation said the reforms represented a big opportunity but should not be seen as a "silver bullet" for the challenges ahead.

Mike Farrar, chief executive of the confederation, which represents health managers, said the squeeze on finances and the need to rebuild public confidence after the Stafford Hospital scandal meant the NHS was facing a critical period.

He said the reforms would bring clinical expertise to the fore of decision making, which would be a "huge asset".

Start Quote

Because GPs have face-to-face contact with patients every day... they are really well-placed to be able to make decisions about how healthcare should be delivered best”

End Quote GP Catherine Briggs

But he warned: "We need to recognise the huge challenges facing the health service. New structures alone won't enable us to tackle these challenges, and we should not see them as a silver bullet.

"Those doing the day-job face major pressures in trying to keep the NHS's head above water, while focusing on making the new world work."

The start of the new system comes nearly three years since the changes were put forward.

The publication of the plans in the summer of 2010 sparked a long and, at times, damaging battle for the government to push through with its changes.

Ministers even had to take the unprecedented step of halting the progress of the bill through Parliament amid criticism from medical bodies, academics and unions.

In particular, concerns have been expressed about what many believe is a greater role for the private sector.

'Compassionate care'

Some have also questioned whether introducing such major changes - they have been dubbed the most radical overhaul since the NHS was created - at a time when money is so tight makes sense.

Start Quote

Far from letting 'doctors decide', ministers are forcing the medical profession to open up all NHS services to the market”

End Quote Andy Burnham Shadow health secretary

But as the new bodies take up control - and the old organisations, including 152 primary care trusts, are scrapped - the government maintained the changes would put the NHS on a firm footing for the 21st century.

Health Minister Anna Soubry said: "The health service will improve, work smarter and, importantly, build an NHS that delivers high quality, compassionate care for patients."

But shadow health secretary Andy Burnham predicted the changes would have the opposite effect.

"Far from letting 'doctors decide', ministers are forcing the medical profession to open up all NHS services to the market.

"Hundreds of new private companies now risk fragmenting patient care when more integration is needed."

GP Catherine Briggs said she would welcome more control over how budgets are spent.

"Because GPs have face-to-face contact with patients every day and because they know their patients and their communities really well," she said.

"That means they are really well-placed to be able to make decisions about how healthcare should be delivered best."

But GP John Hughes said he had reservations.

"The GPs aren't really free to do what they like with the money as a lot of people seem to think," he said.

"Most of the directions as to what happens to that money and what should be bought or commissioned locally is coming from the Department of Health."


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  • rate this

    Comment number 254.

    @242 Hangfire,
    Bang On.
    Here is another regarding West Yorkshire.

    Mid Yorkshire Hospitals NHS Trust staff start industrial action.
    Source BBC Leeds West Yorkshire.Jan 2013.

  • rate this

    Comment number 253.


    As soon as you introduce a profit requirement costs go up to find that profit or quality comes down to find that profit

    This simple fact is why privatisation never has worked and never will

  • rate this

    Comment number 252.

    The Tory government have handed the NHS into private hands - whether it is services out to tender or GP's 'taking control' and awarding themselves lucrative contracts (by the way why aren't police corruption units looking into many of these cases?). If this wasn't happening the Tories would be ensuring the NHS fails completely so they can say it has failed and privatise it then.Tories HATE the NHS

  • rate this

    Comment number 251.

    We can all complain about the changes, but the Labour system wasn't any better with its focus on targets. The only target that should matter is patient outcome, are they well again and are they happy.

    Foundation status is a joke too, Mid Staffs became a foundation trust by slashing costs (i.e.. staff) to demonstrate they were good at money management. Look at the end result.

  • rate this

    Comment number 250.

    Someone call David Milliband....

    The UK is a disaster zone !

  • rate this

    Comment number 249.

    From 234. Bruce Everiss:
    "Mid Staffs has proven comprehensively that labour broke the NHS...Now the coalition are applying some common sense to try and fix it."

    Labour's fault was in furthering Tory privatising motives with 'PFI'. In what weird deluded universe do you think that raw Tory ideology will be better than that? Time to reverse the whole thing and get some nationalised NHS again.

  • rate this

    Comment number 248.

    We pay to train these GPs to spot illnesses, and to book us in for any further specialist treatment. All I want them to do, in exchange for their huge salaries, and public pensions, is to take responsibility for my health care path through that system. History has it that they will just chase the largest returns for themselves, not my best care. Return to what they are trained for, patient care.

  • rate this

    Comment number 247.

    @236.Chorley Lass

    Agree but it will be done by other methods, ie the private sector replacing the NHS delivered services more and more until only uneconomical ones are conducted by the NHS.
    As long as it is free at point of need, whats the problem?
    Something has to be done to reform the NHS before its to late
    Heads in the sand and bleating sentimental dogma is not going to solve anything

  • rate this

    Comment number 246.

    More British people were killed in the Stafford hospital debacle than in Afghanistan"

    In the privatised or get what you can afford healthcare you advocate, these people would have died before getting treated anyway. Not defending Stafford in any way.

  • rate this

    Comment number 245.


    Today is the first day of the end of our NHS, April fool’s day, how appropriate


  • rate this

    Comment number 244.

    Just came out of hospital on Friday after replacement hip surgery. No complaints about that, but with exception of 3 or 4 staff members with whom I had contact, the rest were careless, totally lacking in compassion and there was no continuity of care. I bitterley regret not using my savings
    to have the operation done in a private hospital. NHS never again!

  • rate this

    Comment number 243.

    Well ,the only good thing about this, is that the tories are again, showing themselves for what they really are about. Just like last time. . . give them enough rope and they'll hang themselves.(unfortunately causing more chaos on the way).

  • rate this

    Comment number 242.

    186.Hugo Grotius:"How many more people have to die needlessly in it's "care" before people wake up to the fact that the NHS as it stands is not fit for purpose and needs reforming?"
    How many people will continue to slag off the NHS using bad data as a guide?
    Leeds will close because "an NHS review said surgery would be better focused at fewer, larger sites

  • rate this

    Comment number 241.

    Another change, I think history will suggest that this Government instituted more changes that resulted in massive alterations to many of our cherished organisations such as the NHS, Police, Military strength etc. The changes have been made with little ir no consent from the populace and this, hopefully be their downfall.

  • rate this

    Comment number 240.

    You make a fair point but the aternative, as the Atlantic Bridge tories will implement it, is Medicaid.
    The NHS will never be perfect but we have to fight this corporate cancer.Removal of ideological profit motive interference is a first step along with the removal of the multi layered bean counter structure - but there will be a need for an NGO with real teeth, not gumbashers like Ofgem.

  • rate this

    Comment number 239.

    Every change to the NHS as taken more money out of the NHS even tho the NHS budgets have gone up
    As these changes seem to need more managers to manage less and less front line staff

  • rate this

    Comment number 238.


    As usual you are up to your own abysmal standards. The vast Majority of people in this country work hard but don't get the rewards for their labour. It gets syphoned off by parasites who need the poor to maintain their lifestyle. The Lazy are those that don't produce but manipulate services or offshore jobs for their own greed. I expect you are well aware of this. I don't

  • rate this

    Comment number 237.

    Even accounting for the coalition, 62% of the population did NOT vote the Tories and Lib Dems into Government (and I suspect this may have been a LOT lower if the current setup had been anticipated) – these changes are unconstitutional, immoral and undemocratic.

  • rate this

    Comment number 236.

    The NHS will not cease to exist, because no political party would propose that.

    However, it is appropriate to ask what is what are the changes for, and how and when will the success or otherwise of them be measured.
    Of course there won't be any answer because politicians love to play "blame football" rather than actually be accountable.

    One outcome is certain - reorganisations costs money.

  • rate this

    Comment number 235.

    From 186. Hugo Grotius:
    "How many more people have to die needlessly in it's "care" before people wake up to the fact that the NHS as it stands is not fit for purpose and needs reforming?"

    Keep plugging, Champ!
    The fragmentation and distraction from core practise and care is causing those deaths. Why don't you figure that out for once?! THINK, don't toe the Tory line like a punchdrunk idiot.


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