The Government's reforms signal one of the biggest upheavals for the National Health Service since it was formed 60 years ago, writes Social Affairs Correspondent Victoria Macdonald.
They keep saying it, and it is not an exaggeration because for the first time the vast majority of the NHS budget - perhaps as much as £80bn - will be put into the hands of family doctors.
But it is even more radical than that because for the first time, too, power will be devolved from the Department of Health down to GPs. No more top-down approach is the oft-repeated mantra behind the reforms.
Ministers, including the secretary of state, will no longer be able to intervene when a hospital, for instance, is threatened with closure. Nor is it clear when and how these elected representatives will be held to account when something even more serious goes wrong.
Health unions and royal colleges have already said that they have 'extreme concerns' about greater commercialisation.
Instead there will be an NHS independent board who will oversee the GP consortia. They will in turn buy care for their patients from "any willing provider" which is jargon for an NHS organisation or a private company, a charity or a voluntary organisation. Health unions and royal colleges have already said that they have "extreme concerns" about greater commercialisation.
Read more: NHS reforms and you
Critics believe all this will make it too easy to place profit before care and that services will be closed because they are not financially viable even if they are needed.
The reforms are complex and largely to do with management and bureaucracy although Health Secretary Andrew Lansley insists patients are at the heart of them and that they will address issues such as poor death rates in cancer and heart disease compared with other European countries.
Primary care trusts and strategic health authorities will be abolished and consortia will bring in their own managers (some, of course from the defunct PCTs). The cost of implementing the changes is £1.4 billion but the health secretary says that it will save the NHS more than £5bn by 2014/15 and £1.7bn every year thereafter.
The reforms themselves mean the loss of 24,500 jobs - almost 21,000 of them will be through redundancy.
So far, 141 consortia have signed up to be "pathfinder" groups, covering more than half of England's population. Mr Lansley says they will test out his plans although in reality it is unlikely that he will row back should it be found there are problems. He is utterly committed to these reforms and the timetable is tight - all GP consortia are meant to be in place from 2013. The following year all hospitals will be expected to have become foundation trusts, which again means they control their own budget and have autonomy from central control.
So far, 141 consortia have signed up to be "pathfinder" groups, covering more than half of England's population.
It took some time for voices of dissent to be heard over the reform plans, partly because of their complexity and partly because most people in the health sector do believe that some change is necessary.
The primary concern remains about the speed and scale of the reforms. The Health Select Committee, chaired by former health secretary, Stephen Dorrell, said that it had been surprised by the change of approach between the Coalition programme and the white paper.
"The white paper proposes a disruptive reorganisation of the institutional structure of the NHS which was subject to little prior discussion and not foreshadowed in the coalition programme," the report says.
It adds: "The Coalition programme anticipated an evolution of existing institutions; the white paper announced significant institutional upheaval. The Committee does not believe that this change of policy has yet been sufficiently explained."
And it is the case that none of these reforms were in either the Conservative or the Liberal Democrat's party manifestos. Quite the contrary. From the Tories came, once again, that pledge: "No top down reorganisation" of the health service. You could not get more of a top down reorganisation if you tried.
The National Health Service
Health Secretary Aneurin Bevan opened Park Hospital in Manchester on 5 July 1948 - officially the moment the NHS was born. It was the climax of a wider plan to set up the welfare state after the Second World War, tackling what Sir William Beveridge called the five giants: disease, ignorance, squalor, idlenss and want.
Mr Bevan fought for the NHS, saying in Parliament that the UK could "take pride in the fact that, despite our financial and economic anxieties, we are still able to do the most civilised thing in the world: put the welfare of the sick in front of every other consideration."
Since then it has grown into one of the world's most respected free healthcare systems, and one of the world's largest employers - along with the Chinese People's Liberation Army, the Indian railways and the Wal-Mart supermarket chain.
Staff across the NHS are in contact with more than 1.5 million patients and their families every day. Men and women now live an average of 10 years longer than they did before the NHS was set up.
Source: NHS Choices
17 January 2011
19 January 2011
19 January 2011
- Department of Health dh.gov.uk