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NHS reforms explained
27th March 2012 - After a long struggle, the government’s Health and Social Care Bill has become law, ushering in an era of major reform for the NHS in England. What are the main changes and what will they mean for patients? Read our FAQs.
Why are the reforms being made?
The government says that with rising demand for healthcare and one of the tightest funding settlements the NHS has ever faced, it is no longer acceptable to go on doing the same things in the same way.
It says that while the NHS is a world leader in many fields, in others it lags behind other major European countries.
Ministers have also committed themselves to greater patient choice and allowing the private sector to offer healthcare providing it meets NHS costs.
The changes only apply in England because health is administered separately in Scotland, Wales and Northern Ireland.
Why did it take so long to get the Bill passed by parliament?
Plans to fundamentally overhaul the NHS were first set out in 2010 in a White Paper called Equity & Excellence: Liberating the NHS. This formed the basis of the Health & Social Care Bill.
The Bill included a number of far-reaching and controversial proposals, including abolishing Primary Care Trusts, handing a substantial part of the health commissioning budget to GPs and allowing "any willing provider" to offer NHS services.
The Bill faced opposition for a number of reasons from health professionals and unions. Among the concerns was whether opening up the NHS to competition amounted to part privatisation. There was also concern about the pace of change at a time when the NHS was being asked to make large efficiency savings. A House of Commons committee warned that the government risked testing services "to the limit".
Did the government take notice of the criticism?
In April 2011, despite the Bill already being before the House of Commons, the Health Secretary announced that its passage would be put on hold so that ministers could "listen to, engage with and learn from experts, patients and front-line staff within the NHS".
A two month re-assessment of the proposals led by the NHS Future Forum led to a number of changes in the Bill. Despite this, the government faced substantial opposition in parliament, particularly in the House of Lords.
Who will be running the NHS?
One of the most controversial aspects of the legislation is the removal of the 'duty' of the Secretary of State to provide a national health service.
The Department of Health says that, in future, the Health Secretary will instead have a duty to "promote" a health service, while frontline organisations will take on the role of commissioning services directly.
Will the NHS be less bureaucratic?
The NHS in England faces a period of extensive restructuring.