By Max Clarke

Plans to modernise the National Health Service and put patients at the heart of everything it does were set out in the Health and Social Care Bill, published today.

The proposed changes will lead to better quality care, more choice and improved outcomes for patients, as well as long-term financial savings for the NHS, which will be available for reinvestment to improve care. Under the new measures there will, for the first time, be a defined legal duty for the NHS and the whole care system to improve continuously the quality of patient care in the areas of effectiveness, safety, and - most importantly - patient experience.

Commenting on today’s bill, John Cridland, CBI Director-General Designate, said:

“We support the Government’s plans to modernise the NHS, because this will lead to better services for patients, and ensure taxpayers’ money is spent wisely.

“Allowing the best provider to deliver healthcare services, whether they are a private company or a charity, will spur innovation and choice. But bidders must be able to compete for contracts on a level playing field.”

The bill, however, has also received criticism, with Karen Jennings, Head of Health at Britain’s largest public sector union- UNISON, saying:

“This Titanic health bill threatens to sink our NHS. The only survivors will be the private health companies that are circling like sharks, waiting to move in and make a killing”.

The Health and Social Care Bill 2011 includes proposals to:

* bring commissioning closer to patients by giving responsibility to GP-led groups;

* increase accountability for patients and the public by establishing HealthWatch and local health and wellbeing boards within local councils;

* liberate the NHS from political micro-management by supporting all trusts to become foundation trusts and establishing independent regulation;

* improve public health by creating Public Health England; and

* reduce bureaucracy by streamlining arm's-length bodies.

The plans would improve the NHS in five key ways:

1 patients would be more involved in decisions about their treatment and care so that it is right for them - there will be 'no decision about me without me';

2 the NHS would be more focussed on results that are meaningful to patients by measuring outcomes such as how successful their treatment was and their quality of life, not just processes like waiting list targets;

3 clinicians would lead the way - GP-led groups will commission services based on what they consider their local patients need, not on what managers feel the NHS can provide;

4 there will be real democratic legitimacy, with local councils and clinicians coming together to shape local services; and

5 they will allow the best people to deliver the best care for patients - with those on the front-line in control, not Ministers or bureaucrats.

These measures will also save the NHS over £5 billion by 2014/15 and then £1.7 billion every year after that - enough money to pay for over 40,000 extra nurses, 17,000 extra doctors or over 11,000 extra senior doctors every year. The majority of the savings would come from a significant reduction in bureaucracy following the abolition of strategic health authorities and primary care trusts, and a reduction in management staff by an estimated 24,500 posts. The changes would pay for themselves by 2012/13 and the subsequent savings would give the NHS a stable financial basis for the future.

UNISON, however, argue that the changes will be costly to the NHS, at a time when the Service should be cutting expenditures.

Health Secretary Andrew Lansley said:

"Modernising the NHS is a necessity, not an option - in order to meet rising need in the future, we need to make changes. We need to take steps to improve health outcomes, bringing them up to the standards of the best international healthcare systems, and to bring down the NHS money spent on bureaucracy. This legislation will deliver changes that will improve outcomes for patients and save the NHS £1.7 billion every year - money that will be reinvested into services for patients.

"This is the start of a cultural shift to a patient-centred NHS. The proposals set out today in the Health and Social Care Bill will strengthen the NHS for the future and make the changes that are needed for vital modernisation to put more patients and NHS staff in control."

Sir David Nicholson, NHS Chief Executive, said:

"Central to the Health and Social Care Bill is mobilising the whole of the NHS to improve outcomes for patients and we should all welcome that. The reforms present the opportunity to develop a system designed to deliver that. The values and principles of the service remain unchanged, enshrined in the NHS Constitution and in the work of our staff every day.

"It is critical for the service to keep its focus and purpose of improving quality for patients and to make the reforms a foundation for improvement.

This is a major challenge when we are already planning to make £15-£20bn efficiency savings but I am confident we will be able to do this, to establish a health and care system that achieves the best outcomes for patients."

Paul Burstow, Care Services Minister, said:

"We're updating the NHS for the 21st Century by making it more personal and more local. The NHS will always be free at the point of use and far to all who need it. By trusting patients and carers to make the best choices we will make the NHS focus on delivering high quality and safe care."

Dr Michael Dixon, Chairman of the NHS Alliance, said:

"The current reforms will empower family doctors and their patients to make a real difference to the health services available to local people. Many GPs have been fighting for these reforms for a number of years and after a few false starts, it is good to see the Government is listening and taking the appropriate measures. It is courageous and right. The NHS Alliance welcomes the principles behind the reforms which will put GPs and patients in the driving seat when it comes to raising the quality and efficiencies of services. It is refreshing to see a reform programme that will create a better balance between local and national requirements."

The Bill was published today (19 January 2011). It will proceed through the Houses of Parliament over the coming months.