Intended for healthcare professionals


Reorganisation of the NHS in England

BMJ 2010; 341 doi: (Published 16 July 2010) Cite this as: BMJ 2010;341:c3843
  1. Kieran Walshe, professor of health policy and management
  1. 1Manchester Business School, Manchester M15 6PB
  1. kieran.walshe{at}

    There is little evidence to support the case for yet more structural change

    For many healthcare professionals and managers working in the NHS, last week’s publication of the white paper Equity and Excellence: Liberating the NHS brought unwelcome but familiar news—that the new government plans to reorganise the NHS in England.1 Despite having promised just two months ago in the coalition government’s agreement to “stop the top-down reorganisations of the NHS that have got in the way of patient care,”2 the new secretary of state, Andrew Lansley, announced plans to abolish strategic health authorities and primary care trusts; to create about 500 new general practitioner consortiums to handle healthcare commissioning; to hand over public health responsibilities to local authorities; to strip the Department of Health of many of its functions and to create an independent NHS board to take them on; to force all NHS providers to become NHS foundation trusts; and to restructure arrangements for healthcare regulation. Little of the current architecture of the NHS will survive these changes unscathed. The white paper, written at breakneck speed in about six weeks, is long on rhetoric but short on detail and specifics. It promises at least seven further strategy or consultation papers on various topics and another white paper, on public health, in the autumn.

    For someone who has spent more than six years mastering the health brief in opposition, Andrew Lansley seems to have learnt little from …

    View Full Text

    Log in

    Log in through your institution


    * For online subscription