All change!

The changes which have been announced by new Health Secretary Andrew Lansley have been dubbed the most far reaching since the NHS was founded in 1948.

Targets are mostly gone - such as the 18 weeks required from referral to treatment - or relaxed - such as the four hour wait in A&E. In place of targets we are promised 'radical transparency' - information on outcomes throughout the service so we can decide not just which hospital to use but also which doctor.

There will be renewed focus on mortality - death rates from some conditions, including asthma, are higher in UK than in some of our neighbours. The promised confidential enquiry into asthma deaths will be part of that. In future, NHS services will be measured by outcomes and by quality, which will influence how much they are paid. Hence hospitals will not be paid if a patient requires an emergency re-admission within 30 days.

Most radically, control over £80 billion of the NHS budget will be removed from Primary Care Trusts (who essentially organise the care we receive) and passed to groups of GPs, who will in future decide what kind of services are needed. They will be overseen by a new independent NHS Board, mirroring Labour's gift of independence to the Bank of England in 1997.

Patients will get much more clout in the system too, although fewer details have been published about what this means.

In essence, this is a vision in which improvement is driven not by targets and active government but by patient power and professional autonomy.

There is much that is good about the proposals but it is also a huge unheaval at a time when the NHS is trying to make £20 billion of savings. Some of the proposals also remain untested.

GP commissioning could work, especially if consortia involve other primary care professionals such as nurses and pharmacists.

But it is not yet clear if this is a recipe for improving services where they are currently weak. At present, there are many fewer GPs in poor areas than there are in more affluent areas and those who work there are often single handed and not part of a larger practice. To improve outcomes we need to re-engage people who currently bypass primary care, which can mean a very different pattern of provision. Whoever commissions care, we need to build on existing practice and introduce new services.

More details will come in a White Paper soon. One thing to mark, though, is that asthma remains a priority for the NHS. Indeed, I was delighted to hear Andrew Lansley speak about avoidable asthma admissions in one of his first speeches as Health Secretary.

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