NHS shake-up: What's new?

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The NHS is facing a major overhaul under plans being implemented by the government.

The shake-up was first set out last summer. A 350-page health bill and a host of supporting documents have now been published.

The legislation had been eagerly awaited to see what safeguards would be put in place and whether the government was sticking to its plans in the face of much opposition.

What have we learnt about the changes?

There is going to be no let up in the reform programme

The message is clear - the changes are going to happen.

A few concessions were made in December when the government published its response to the consultation to the white paper, which was unveiled over the summer.

But the bill and subsequent announcements suggest the government will not be deviated from its course.

The system will go live in 2013. Indeed, this week it emerged that GPs covering half the country had already signed up to piloting the changes.

The changes are going to cost a lot money

The cost of the programme is £1.4bn.

Most of that will come in the next two years as more than 20,000 management and administration staff are made redundant from health authorities, primary care trusts and the Department of Health.

It could cost as much as £1bn to make redundancies. Another £400m will be spent on things such as IT and property in setting up the new consortia.

But the government claims the cost will be more than off-set by savings.

The reduction in staff alone will save £5bn by 2015, according to the government's own costings.

NHS hospitals could go bust

In a market, an organisation can only stay afloat if it attracts customers.

The NHS works in a similar way. Money follows the patients and so if a NHS trust is not seeing enough people it will run into financial difficulty.

In the past, politicians have often claimed they would not let trusts go under.

But the health secretary accepts this could happen in the new NHS.

However, the market is not being given a complete freedom.

A pot of money will be set aside which can be used by the regulator to allow essential services to be kept running.

GP consortia will be closely monitored and regulated

They will be expected to publish annual reports on their performance.

Feedback will be gathered from patients through the HealthWatch network, an umbrella body of patient groups.

The bill also sets out a duty on them to maximise access to a wide range of services.

This is seen as important as concerns had been voiced that some of the more marginal services, such bunion removal, could be hit if GP consortia do not see them as a priority.

GP consortia will also face being financially penalised if they underperform, as a proportion of their income - the so-called quality premium - is linked to them reaching certain standards.

The experts and unions are still not convinced

There is a wide range of opinion. Some, such as Unison, are predicting the end of the NHS as we know it.

The British Medical Association, perhaps the most powerful of the NHS unions, was a little more tempered in its criticism, calling it a "massive gamble".

Others are concerned the health service will simply not be able to do what is being expected.

The King's Fund is concerned the scale and pace of the changes at a time when the NHS is having to save money will mean the government's vision is not realised.

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