The changing health service

Image caption The shake-up will pave the way for the NHS in the 21st Century.

The government's NHS shake-up in England comes into force on 1 April.

The changes have been dubbed the most radical in the history of the health service - and have certainly proved controversial.

At one point, the overhaul threatened to tear apart the coalition and ministers had to take the unprecedented step of halting the progression of legislation through parliament after criticism from MPs and health unions.

The bill underpinning the changes gained Royal Assent in March 2012 and after a year of planning the changes are finally taking place.

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.

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.

This is because of factors like the ageing population, costs of new drugs and treatments and lifestyle factors, such as obesity.

Without change, the government argues, services would increasingly have to be rationed in the future.

So what is changing?

GP-led groups, called clinical commissioning groups, will be put in charge of a large chunk of the NHS budget. It will be up to them to decide how to spend funds on local services, from hospitals to community-based clinics.

There are 211 of these groups and they replace the role performed by primary care trusts.

Strategic health authorities, which provide oversight, are also being scrapped.

That job will now be done by the NHS Commissioning Board, headed by Sir David Nicholson.

The board will also be responsible for the budget for specialist services, such as complex surgery and rare cancers, and other areas, such as dentistry.

What about competition?

The shake-up is partly designed to encourage greater involvement from the private sector and charities.

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.

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 total, £1 of every £20 spent in the NHS goes to a non-NHS provider.

The changes 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 saying they will introduce competition in a more managed and balanced way. Not everyone is convinced though.

Don't councils have a key role?

Yes. They will be taking charge of public health. That includes everything from running obesity programmes and stop smoking services to promoting healthy lifestyle through responsible drinking and physical activity.

Local government has already been playing an active role in many of these areas through partnership work with primary care trusts, which have been officially responsible for public health in recent years.

The thinking behind the move is that as councils have powers over everything from schools and planning to leisure services they can have a huge influence over how we live our lives.

To help them get started, they have been given a ring-fenced budget - just under £3bn a year.

But councils will also have an important say on health care through the creation of health and wellbeing boards, which will promote co-ordination of services between hospitals, community health services, social care and public health.

What difference will patients notice?

Probably nothing on day one. They will still walk into their local GP surgery of hospital just as they always have.

However, over time the shake-up will go a long way to determine what sort of health service develops in the 21st Century.

The theory behind giving GPs more of a say over the budget was that they would be more responsive to the developing needs of patients.

About two-thirds of the NHS budget is spent on people with long-term conditions, such as heart disease, diabetes and dementia.

There are no cures for these diseases. Instead, the challenge for the NHS is how to best manage these patients to allow them to live independent and healthy lives and, as a result, keep them out of hospital.

This is likely to see a range of community-based services develop to bridge the gap between GP and hospital care. This is commonly referred to as integrated care.

It can involve everything running outpatient appointments and minor surgery in the community to improving the support and rehabilitation available to patients when they are discharged from hospital.

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