'Devolved' NHS in action tomorrow

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A far-reaching reorganisation of the health service comes into force tomorrow, when control of much of the system passes directly to front-line health workers.

Alan Milburn, the Health Secretary, has rushed through plans to devolve cash and choice to local communities in just a year, despite concern from experts that the process should have taken longer.

But with pressure on the Government to deliver on its promises on public services, 50 per cent of all cash will go to 300 primary care trusts. By 2004, it will be 75 per cent.

The new arrangements – being sold as "half a century of centralised health care disappearing overnight" – are expected to give more power to patients.

"We are seeing a big devolution of power and resources. It is more radical than the creation of the internal market," a Department of Health spokesman said. The comparison between the Tory internal market and the new revolution in health care will do little to quell concern on Labour's back benches.

Patients will be able to book their own hospital appointments through their GPs. They will also have more power to choose where and how they are treated.

Primary care trusts, which look after about 170,000 patients each, will also be able to establish the health care needs of people living in their area and target resources accordingly. The trusts will be required to publish accounts.

The changes tomorrow form the next step of Mr Milburn's reform of the health service, which was demanded by Gordon Brown, the Chancellor of the Exchequer, in return for more money to fund better services.