Changes to the Health and Social Care Bill: structural changes

The comparison below sets out the Health and Social Care Bill's initial proposals as regards structural changes, explains what in the Bill has now changed and some key questions that remain unanswered.

The original proposals in the Health and Social Care Bill

  • Strategic health authorities to be abolished from April 2012 and primary care trusts by April 2013.
  • NHS Commissioning Board to be operational from April 2012.
  • These changes to be implemented alongside a 45 per cent cut in management costs.

What has changed in the proposed reforms?

  • The deadline for abolishing primary care trusts has been retained; PCT clusters will become local outposts of the NHS Commissioning Board with responsibility for overseeing commissioning groups from April 2013.
  • The deadline for the abolition of strategic health authorities has been extended to April 2013. In the meantime, they will retain responsibility for NHS finances and be slimmed down into a small number of clusters.
  • The NHS Commissioning Board will not take on its full responsibilities until April 2013.
  • The government's response to the NHS Future Forum emphasises the importance of good management and leadership.

What is still unanswered?

  • Will the number of changes being made to the structure of the health system result in confusion and additional bureaucracy?
  • Will the NHS Commissioning Board be the 'lean and expert' body described in the NHS White Paper?
  • Will there be sufficient management capacity to manage the transition?
  • Will the structural reforms undermine efforts to find the £20 billion in productivity improvements needed to maintain quality and avoid significant cuts to services?