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Lords debating NHS shake-up bill Q&A: The NHS shake-up
(12 days later)
The government wants to overhaul the way the NHS in England works.The government wants to overhaul the way the NHS in England works.
Under the plans, GPs and other clinicians will be given much more responsibility for spending the budget in England, while greater competition with the private sector will be encouraged.Under the plans, GPs and other clinicians will be given much more responsibility for spending the budget in England, while greater competition with the private sector will be encouraged.
It has been dubbed one of the most radical plans in the history of the health service - and has certainly proved controversial.It has been dubbed one of the most radical plans in the history of the health service - and has certainly proved controversial.
Ministers even had to take the unprecedented step of putting the plans on hold in the spring after criticisms from MPs and health unions. Ministers even had to take the unprecedented step of putting the plans on hold last spring after criticisms from MPs and health unions.
The government has now agreed to make changes after an independent review called for parts of the plans to be re-written. After carrying out a "listening exercise" they agreed to make changes, but this has still not been enough to appease critics.
Why does the government want to make changes? A host of health groups have recently said they totally oppose the plans - and these include some royal colleges which set professional standards as well as the major unions representing doctors, nurses and midwives.

Why does the government want to make changes in the first place?

Ministers believe they are essential to allow the health service to become more efficient and meet the challenges it is facing.
Despite the NHS budget being protected, it is not immune from the need to make savings.Despite the NHS budget being protected, it is not immune from the need to make savings.
In fact, financially many believe the next few years will be the most challenging in its history.In fact, financially many believe the next few years will be the most challenging in its history.
Costs in the NHS are rising at a much higher rate than inflation.Costs in the NHS are rising at a much higher rate than inflation.
This is because of factors like the ageing population, costs of new drugs and treatments and lifestyle factors, such as obesity.This is because of factors like the ageing population, costs of new drugs and treatments and lifestyle factors, such as obesity.
To cope, the NHS has been asked to make savings of up to £20bn by 2015. Without change, the government argues, services would increasingly have to be rationed in the future.
To put that in context, it would require the NHS to become 4% more productive each year. And that is for a service that some claim has become gradually less productive over the past decade.

class="section-header" id="heading-1-1">Who is responsible for the budget now and how is that changing?

If it does not meet the challenge services will undoubtedly suffer. There could be more rationing and longer waiting lists.
Ministers believe overhauling the way the system works could help the NHS meet this challenge.
Who is responsible for the budget now and how is that changing?
Local health managers working for primary care trusts (PCTs) currently control much of the spending. They use the funds to plan and buy services for patients including community clinics, mental health units and hospital care.Local health managers working for primary care trusts (PCTs) currently control much of the spending. They use the funds to plan and buy services for patients including community clinics, mental health units and hospital care.
The changes will transfer much of that responsibility to clinical commissioning groups.The changes will transfer much of that responsibility to clinical commissioning groups.
Although it is likely responsibility for services such as dentistry and specialist care like neurosurgery will end up with the national board that is being set up to oversee the new system.Although it is likely responsibility for services such as dentistry and specialist care like neurosurgery will end up with the national board that is being set up to oversee the new system.
Originally, the commissioning groups were to be led by GPs, but other professionals including hospital doctors and nurses will now be involved too.Originally, the commissioning groups were to be led by GPs, but other professionals including hospital doctors and nurses will now be involved too.
As the changes happen, both PCTs and regional bodies known as strategic health authorities are to be phased out.As the changes happen, both PCTs and regional bodies known as strategic health authorities are to be phased out.
What about competition?

class="section-header" id="heading-1-2">What about competition?

The reforms are partly designed to encourage greater involvement from the private sector and charities.The reforms are partly designed to encourage greater involvement from the private sector and charities.
In many ways, this is nothing new for the NHS.In many ways, this is nothing new for the NHS.
Under Labour, they were encouraged to get involved, especially in elective operations such as hip and knee replacements.Under Labour, they were encouraged to get involved, especially in elective operations such as hip and knee replacements.
However to date, just 3.5% of these operations are done by the private sector.However to date, just 3.5% of these operations are done by the private sector.
In other areas of health care, especially mental health, the role of other providers is much more pronounced.In other areas of health care, especially mental health, the role of other providers is much more pronounced.
In total, £1 of every £20 spent in the NHS goes to a non-NHS provider.In total, £1 of every £20 spent in the NHS goes to a non-NHS provider.
The reforms will probably expand this - something that has proved extremely controversial and opened up the government to claims it is going to privatise the health service.The reforms will probably expand this - something that has proved extremely controversial and opened up the government to claims it is going to privatise the health service.
Ministers have responded by agreeing to introduce competition in a more managed and balanced way.Ministers have responded by agreeing to introduce competition in a more managed and balanced way.
They also point out that it is not all about the private sector. Social enterprises are also being encouraged to get more involved.They also point out that it is not all about the private sector. Social enterprises are also being encouraged to get more involved.
Although critics say that social enterprises often find it difficult to compete against the much wealthier private health organisations.Although critics say that social enterprises often find it difficult to compete against the much wealthier private health organisations.
How much will the changes cost?

class="section-header" id="heading-1-3">How much will the changes cost?

The cost of the programme is £1.4bn.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, PCTs and the Department of Health.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, PCTs 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.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 offset by savings.But the government claims the cost will be more than offset by savings.
The reduction in staff alone will save £5bn by 2015, according to the government's own costings.The reduction in staff alone will save £5bn by 2015, according to the government's own costings.
What happens next?

class="section-header" id="heading-1-4">What stage are the changes at?

The pause that was put in place while the listening exercise was carried out was lifted in the early summer. Since then, it has been all systems go again. The bill underpinning the changes is still working its way through Parliament.
On the ground, pilots have continued being rolled out. After last year's pause it completed its initial passage through the House of Commons.
Meanwhile, government officials have made amendments to the original bill following the recommendations of the independent panel which looked at the proposals. But it has run into problems since it was passed on to the House of Lords in the autumn.
The legislation is now working its way through Parliament. The bill begins its report stage in the House of Lords on 8 February when a series of government amendments seeking to win over critics are being debated. Peers have been demanding a number of changes be made to the legislation, which has slowed down the process and resulted in political ping-pong.
Those amendments have yet to win over the royal colleges and health service unions who are opposing the bill. This is happening at a time when there is growing disquiet away from Westminster.
But the government's aim is that the clinical commissioning groups will take responsibility for the budget in April 2013. As already mentioned, a number of health groups have come out in the last few months to oppose the plans.
However, under one of the concessions to critics, those areas that are not ready to take charge will not have to. There are also suggestions some members of the cabinet are getting cold feet along with some Lib Dems.
Instead, the national board will be in charge of the purse strings until they can get their arrangements fit for purpose. Meanwhile, Labour has also been piling on the pressure, dubbing it David Cameron's poll tax.
Nonetheless, on the ground it has been all system go. The government insists it wants the system up-and-running by next April.
As a result, pilots have been set up across the country to test the new system and PCTs have started merging as managers have left the NHS in droves.