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Since 2011, the NHS has undergone significant change. Much more power has been given to doctors; they now have responsibility for around 80% of total (government-funded) budget. Previously the NHS management structure was more complicated than it is becoming (including regional overseers and trusts who ‘did the management stuff’).

While a Commission Board (representing the Government) still has ultimate power to intervene in problem cases, doctors now hold more power than ever before to run their health practice in the ways they see fit. The changes have clearly had an impact on issues surrounding control, strategy, planning and the like.

The changes have stream-lined overall structure of the NHS, and will have a significant impact on the management information used in healthcare. It also increases accountability towards ‘performance’ in the NHS. There is talk of needing to be more financially astute, especially in times of global austerity, budget cuts, etc. There is also more expectation of patient satisfaction and increased quality in care provision. Doctors are expected to provide leadership and new ways of working will emerge – e.g., some hospitals have already outsourced parts of their management process to an external provider; others are expected to merge and/or engage in joint ventures.

Some have argued that this represents the biggest change programme since the NHS was introduced. In terms of Chapter 22’s discussion, this is maybe ‘revolutionary’ change. Others disagree, and stress that the NHS has been undergoing other changes over the past 20 years which will act as pre-cursor for the current changes – e.g., doctors have managed their budgets for many years and the government’s control over health practices has become more arms-length for quite a while. This therefore suggests potential of a more ‘evolutionary’ change process, whereby the reforms of 2011 onwards actually build on changes already underway.

Source: ‘Why the NHS must face up to the new world”, N. Triggle, BBC News ‘Health’ website, 25.2.11