This project completed on
8 May 2015

The coalition Government has embarked on an ambitious and widespread reform programme following the 2010 general election. The centerpiece of the reforms, the Health and Social Care Act 2012, introduces substantial changes to the way the NHS in England is organised, while work is also underway to improve the quality of social care and reform its funding. Our experts are engaging with the reform agenda through our research programme and debates.

This slideshow shows the key changes to the English NHS that went 'live' on 1 April 2013.

The Health and Social Care Act 2012

The Health and Social Care Act introduces a number of key changes to the NHS in England. These changes came into being on 1 April 2013. The changes include:

  • giving groups of GP practices and other professionals – clinical commissioning groups (CCGs) – 'real' budgets to buy care on behalf of their local communities;
  • shifting many of the responsibilities historically located in the Department of Health to a new, politically independent NHS Commissioning Board (this has now been renamed NHS England);
  • the creation of a health specific economic regulator (Monitor) with a mandate to guard against 'anti-competitive' practices; and
  • moving all NHS trusts to foundation trust status.

The Act came in for substantial criticism when it was published in draft form in January 2011 and its progress through parliament proved politically difficult.

The Bill was temporarily paused in spring 2011 in order for a 'listening exercise' – led by a panel of experts in the NHS Future Forum headed by Professor Steve Field – to review the proposals and make recommendations.

To inform the NHS Future Forum's analysis, we produced an important submission: The Health and Social Care Bill: where next? (May 2011). The Future Forum’s recommendations of 13 June 2011 and the Government response echoed strongly many of the points raised in our report.

We followed this up with a further briefing for peers in advance of their first debate. Before the Bill reached the Lords, we had provided a briefing for MPs taking part in the second reading, and a final briefing followed which examined the Lords amendments.

Rt Hon Stephen Dorrell MP, Health Select Committee, on how optimistic he is that the NHS reforms will improve patient experience & increase efficiency.

Alongside these papers, you can also watch a recording of Nuffield Trust Chief Executive Dr Jennifer Dixon's appearance before the panel of MPs who were charged with examining the Bill in detail following the NHS Listening Exercise.

Now the Act has received Royal Assent, our experts continue to examine the secondary legislation as it is published. We continue to provide impartial, expert analysis of the legislation and its consequences.

Understanding the 'new' NHS

The Government's reforms to the English NHS became fully operational on 1 April 2013. We have produced a number of resources that help explain the reforms:

NHS White Paper: Equity and Excellence: Liberating the NHS

The Health and Social Care Bill was preceded by the White Paper: Equity and excellence: Liberating the NHS, published in July 2010.

We played a lead role in the debates leading up to and beyond the publication of the White Paper and Spending Review, and responded with a comprehensive analysis of the key reforms and developments in:

Social care reform

Against a backdrop of concerns about the implications of an ageing population for the affordability of long-term care, the coalition Government announced new measures in February 2013 for funding care to ensure that the elderly and those with disabilities get the care they need without facing 'unlimited costs'.

The new measures, which would only be implemented from April 2017 depending on the outcome of the 2015 general election, are based on the principles and recommendations outlined by the Dilnot Commission in 2011. This was an independent panel set up to look at the fairest and most sustainable way to fund care and support in England.

We are conducting a range of activities to inform this crucial debate. Our report: Reforming social care: options for funding (May 2012), examines various options for paying for social care in the short and longer term. With support from the AXA Research Fund we are also investigating how private long-term care insurance can supplement state systems, using the UK as a case study.

Other major developments: the NHS in 2012/13

The Chancellor's 2013 Budget reiterated the Government's commitment to protecting the NHS budget. Read a blog by Nuffield Trust Chief Economist Anita Charlesworth which examines the implications of the Budget for the NHS.

Her analysis should be read alongside the NHS Operating Framework 2012/13 which holds out the prospect of another very challenging year.

Hospitals and commissioners face a drop in prices of at least 1.5 per cent while commissioners must manage the transition to the new structures set out in the Health and Social Care Act 2012.

In our response to the Operating Framework we urged the NHS Commissioning Board (which has now been renamed NHS England) to use its 'shadow' year to balance financial discipline with work aimed at encouraging more local innovation across the health service.

Further background on our position is available in the policy response: NHS reforms in England: managing the transition (March 2011).

Project outputs



Press release


  1. Reform and the national health service

    15 Feb 2012
    The Political Quarterly

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