The Government’s highly controversial proposals to reform the NHS are due to be debated in the House of Lords today. Health Editor Barry Nelson answers some of the questions readers may have.

Q What is the purpose of the Health and Social Care Bill?

A The Coalition Government believes it is time to reform the NHS in order to promote efficiency, improve its effectiveness and reduce waste. The Government believes it can streamline management, put decision-making into the hands of doctors, nurses and other health professionals, and open up the NHS to more competition.

Q Why is the Government in such a hurry to change everything?

A Britain is facing the challenge of meeting the health needs of a population which is ageing and – in many cases – suffering the illeffects of having an unhealthy lifestyle.

In addition, the NHS is under pressure to find more and more money to pay for new drugs and treatements.

To show how serious the funding problem is, the NHS is being asked to make efficiencies – or savings – of £20bn by 2015.

The Government believes that its reforms should help the NHS to meet these challenges.

If the reforms do not work, we might see the return of longer waiting lists and more rationing of NHS care.

Q Hasn’t the NHS improved in recent years?

Why fix something that isn’t broken?

A Yes, it has improved, but at a cost. Billions of pounds were ploughed into the NHS by the last Labour Government, resulting in many new and refurbished hospitals being built. The number of doctors, nurses and other health professionals increased and, in general, more patients were seen faster and given better treatment.

The Coalition Government has said it will continue to increase funding for the NHS, despite the economic downturn, but has ordered major reforms to increase efficiency and bring down costs.

Q Who will be in charge of funding and how will that be different from what happens now?

A Currently, the bulk of NHS spending is controlled by managers working for health authorities known as primary care trusts (PCTs).

The funds are used to plan and buy services for patients in hospitals, in local health clinics and for mental health services.

Under the proposed legislation, the job of planning and buying services for patients will be given to clinical commissioning groups (CCGs).

Originally, these groups were to be made up of GPs, but the Government has now agreed to allow the groups to include hospital doctors, nurses and other health professionals.

Although most spending will be controlled by these groups, the Government is planning to set up a national NHS commissioning board to plan and purchase specialist services, such as dentistry and neurosurgery.

The national board will temporarily take over the functions of CCGs if they are not ready to take control of local budgets on April 1, 2013.

Q So, what is actually being abolished and what will happen to staff?

A If all goes according to plan in April 2013, the existing strategic health aAuthorities (SHAs) and PCTs will be abolished. In the intervening two years, about 20,000 managers and administration staff will have been made redundant.

While the Government reckons this will save about £5bn by 2015, the cost of making so many staff redundant is thought to be about £1.4bn.

There is also an estimated £400m which will need to be spent on setting up the CCGs.

Some managers from the old SHAs and PCTs are expected to be employed by the CCGs.

Q Critics say the changes are softening up the NHS for privatisation. Is that fair comment?

A The Government has made it clear that it wants the NHS to be opened up to more competition. It believes this will encourage efficiency and promote good practice.

It will almost certainly lead to more NHS contracts being won by private health companies and by charities.

The Coalition Government points out that the private sector has been providing more and more services on behalf of the NHS and that they are, arguably, carrying on the work of the last Labour Government.

The Labour administration encouraged the private sector to set up and run independent sector treatment centres, providing planned operations such as knee and hip replacements.

Q Why has it taken so long to pass the legislation?

A From the outset, most of the organisations representing doctors, nurses and NHS bodies have been critical of the proposals.

This led to an unprecedented decision to put the proposals on hold, hold a consultation and then reintroduce it in both Houses of Parliament after a number of minor amendments.

Q Is the new Health and Social Care Bill expected to be passed now?

A While MPs in the House of Commons have passed the Bill – because of the majority enjoyed by the Coalition parties – the proposed reforms are expected to be given a very close examination by members of the House of Lords.

It is not expected that the peers will block the legislation, but an amendment calling for part of the Bill to be referred to a select committee for further analysis seems to have a reasonable chance of being passed.