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Health Secretary Andrew Lansley Announces Major Health Reforms

Secretary of State for Health Andrew Lansley laid out the new Coalition Government's plan for health care reform in the white paper, "Equity and Excellence: Liberating the NHS," published July 12, 2010. The plan detailed in the paper envisions broad decentralization of the English National Health Service (NHS) in what some commentators have described as the greatest overhaul of the NHS since its inception in 1948.

The government will phase out England's 150 primary care trusts and 10 strategic health authorities. They will be replaced by approximately 500 general practitioner (GP) consortia. These consortia will be GP-led and responsible for purchasing care on behalf of their patients and, in total, be responsible for more than 80 percent (£80 billion, or US$126 billion) of the NHS spending. Commissioning and payment would be guided by quality standards to be developed by the National Institute for Health and Clinical Excellence (NICE) and overseen by a new NHS Commissioning Board.

Patients, guided in the NHS by the new principle, "no decision about me without me," will be given greater choice—including choice of provider, GP practice, and treatment—as well as increased control over their personal care records. A new consumer advocacy body, HealthWatch England, situated in the Care Quality Commission, would further support patients' rights.

The proposal would also increase openness to the private sector by increasing social enterprise in the NHS, allowing private companies to compete with the NHS, and by transforming Monitor, the NHS body currently overseeing the foundation trusts, into an economic regulator overseeing and promoting a competitive health care market.

Finally, the proposal announces the Government's aim to achieve £20 billion (US$31 billion) in efficiency savings by 2014 and to reduce NHS management costs by more than 45 percent; savings would be reinvested to support quality and outcome improvements.

The proposal set out in the white paper remains subject to Parliamentary approval.


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