Policy response
27 May 2011

The NHS in England is about to embark on a major programme of reform. This briefing provides the Nuffield Trust response to the Government’s NHS ‘listening exercise’, in which Ministers will consider options for reform before the Health and Social Care Bill returns to Parliament.


The period from 2011 to 2014 is likely to be the most challenging ever faced by the NHS. Four per cent in efficiency improvements each year to 2015 must be achieved without damaging the quality of care patients receive. This period can be called ‘phase 1’.

Structural reform aimed at ensuring sustainability – the provision of good quality care within the resources likely to be available in the medium to longer term – will also be necessary (this period can be called ‘phase 2’).

The Bill will not make a major contribution to the immediate financial challenge facing the NHS

The policy response asserts that disagreements on the Bill must be settled quickly so the NHS can focus on achieving the unprecedented efficiency savings it has been charged with delivering. Key recommendations include: ensuring a role for competition and collaboration between providers; a rejection of calls to scrap plans for a health care economic regulator; mandatory membership of clinical commissioning groups; and a longer term future for primary care trust (PCTs) clusters beyond 2013.

This response builds on our previous contributions to the NHS White Paper (published in July 2010) and our previous research and analysis published in:

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