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 274.

    I don't really have a problem with the central reforms, but what I do have a problem with is all the little bits the CON party will have chucked in.

    You can bet that quietly hidden away in there will be gaps in the provision of treatment for those the CONs don't like.

    You can be sure that hidden in there will be little financial mechanisms that allow sale of assetts and big business scams.

  • rate this

    Comment number 273.

    The NHS will be sold to foreigners bleeding money abroad, just like the utilities, transport etc.

    clegg, top up fee's = LIAR
    cameron NHS = LIAR

    Remember next election day.

  • rate this

    Comment number 272.

    Lets be honest, we expect this from the Tories. But the LibDems having sold their souls to the devil for their moment of power are the ones aiding and abetting the Tories, without the LibDems help none of this could have gone through. Hopefully people will remember this at the next general election and then the LibDems will go the same way as the NHS has just done.

  • rate this

    Comment number 271.

    2 Hours ago

    Well done to the Government for beginning to address this last bastion of socialist inefficiency.


    Yes the privatised railways are very efficient. So much so in fact that they are propped up by the taxpayer to the tune of £4 billion a year which is more than 40% of the total running costs. Criminally inefficient and parasites to boot.

  • rate this

    Comment number 270.

    When will the people of this country stand up and say no more. Please remember at the next election which politicians pushed the destruction of the NHS through. Please don't wait until you are in the unfortunate position of being in an A&E department waiting for treatment or in a hospital bed waiting for a member of staff to bring you a glass of water!
    Politicians think we have short memories

  • rate this

    Comment number 269.

    165. Guttersnipe
    Doctors are doctors not accountants. This is a recipe for disaster.
    As it happens my son is both - chartered accountant and mid seniority surgeon. He is clear that, on average, about 10% could be saved by better management and less wastage. He is surprisingly poorly paid for his life responsibilities and extremely anti-social hours. Oh, he has a 10 year old car!

  • rate this

    Comment number 268.

    They have scrapped the national health service. And the bbc has stayed eerily quiet!

  • rate this

    Comment number 267.

    Insurance is mandatory now. It's called "tax". Unlike insurance however I have no choice of cost, level of cover, or provider
    Spoken like a true Care UK rep.
    You're right to highlight tax as the issue but then you bally well forget to mention the the colossal tax gap is a major problem - it won't solve everything but by god it will make a difference if we collect what is already due.

  • rate this

    Comment number 266.

    A fundamental issue is the attitude of many NHS doctors. The sense, as the service is ‘free at point of delivery’, that the patient is being done a favour. Ever tried even politely complaining? No proper feedback mechanism. Deaf to legitimate patient concerns. In my local hospital a couple of recent experiences got met with ‘passive aggression’ and no credible or professional response.

  • rate this

    Comment number 265.

    We are one more step, one more snip, one more cut from a complete stitch up. It seems, they think, the patient is not worth saving, the corpse, unable and not needing to turn out the light. A great darkness settles, a nuclear winter, with no social nucleus. greed is self, and too many are nothing but self.

  • rate this

    Comment number 264.

    Oh what a tangled web we weave -
    They do love to keep changing names and the positions of Hospital CEOs.
    It is my understanding the NHS Commissioning Board and the Department of Health are now combined into the new name of NHS England , its Chief executive officer is Sir David Nicholson and its medical Dierctor is Professor Sir Bruce Keogh. Wonder how they got to be named Sir?

  • rate this

    Comment number 263.

    The threat to the NHS is not competition or the independent and voluntary sector providing services. The threat is from GP's deciding locally what patients can and can not receive in their locality. How does local rationing fit with a service which is supposed to be "national". Watch for GP's awarding themselves contracts to provide services in their locality & denying patients choice of provider.

  • rate this

    Comment number 262.

    Why this race to sell off? The water companies, that we all previously owned anyway, were sold off, and now we have Southern Water pumping "dilute" raw sewage into our river. Diluted with what? Well, other people's bathwater, for example! 21st century services in a developed nation??
    So where is my local hospital going?

  • rate this

    Comment number 261.

    Millionaires in the Cabinet now messing with the NHS. Those who have money will never understand those at the lower end of the scale whose lives are being turned upside down by changes to welfare benefits and now the NHS hotline.The rich are not affected they can afford private medicine. How many will die due to inefficiency. being cynical maybe that is the plan...............

  • rate this

    Comment number 260.

    A health Service run by Accountants is never a good thing, profit over health is whet you have now with the private sector

  • rate this

    Comment number 259.

    the NHS is in the HD unit. cuts are away of culling by the back door. it is sure the NHS will just be come a safetynet and will give basic health care. if you wont more you will have to pay. Like pay to live, or die.

    The Torys have never like the HNS has it is a Labour idear. people in hight paid job may yes cut, cull and reform, untill it hits them. do not for get no ones job is safe

  • rate this

    Comment number 258.

    We will not persist with the top-down re-structures and reorganisations that have dominated the last decade in the NHS.

    David Cameron 2009

  • rate this

    Comment number 257.

    We should privatise the Government and get some professionals to run the country. These self-serving amateurs haven't a clue what they are doing and are destroying OUR health services, educational systems, economy,.... You name it, they're breaking it.

  • rate this

    Comment number 256.

    That link is quite a shock isn't it - when you some of the names who are "consultants" for pharmahealth

    Parliament is now Americanised comprising two sets of right of centre bank/business lobbyists with no connection to the population other than via the medium of lies and deception that is called the media.

    We should acknowledge that our Republican/Tea Party Government is fully purchased.

  • Comment number 255.

    All this user's posts have been removed.Why?


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