World News Today: Unlocking potential

Ministers believe their reforms will lead to better care

Primary care trusts, clinical senates and commissioning groups. The list goes on.

The government's NHS reform programme in England has been an epic saga. But it has almost entirely focused on structural changes and policy U-turns rather than the patient experience.

In truth, that is because the immediate effect on patients is hardly noticeable.

But in the long term the reforms could - if the government is right - herald a whole new era of health care.

The government has pushed ahead with the changes in the belief that they will help meet the twin challenge of rising demands and tightening budgets.

The simple response to such a scenario - and the one that ministers are keen to avoid - is rising waiting lists and ever-greater rationing of services.

But the alternative vision is one where through better decision-making the potential of the NHS to provide more effective and revolutionary care is unlocked.

So how could the patient experience change in the next five or 10 years if that does happen?

Stroke services in London give a clue to what could happen in a whole host of complex areas of care.

Nearly two years ago services were redesigned so patients with symptoms were no longer taken to their nearest hospital.

Instead, ambulances ferry them to one of eight specialist centres that have expert staff and facilities on hand 24 hours a day.

The overhaul is estimated to be saving 400 lives a year and London is now rated as having the best stroke service in the country.

Similar moves are under consideration for other parts of the country and for other specialisms, from heart surgery to cancer care.

But that in turn raises question marks about the future of district general hospitals that have been the bedrock of the health service since its inception.

Spending on their diseases takes up about 70% of the NHS budget, mainly because they end up in hospital too often.

But increasingly these groups of patients are being encouraged to "self-care" in an attempt to manage and control their conditions.

For something like diabetes that means monitoring blood-glucose levels - a relatively simple and inexpensive measure.

In the US it is not unusual for patients to interact with their doctor over the internet or via mobile-phone technology.

When the NHS was created in 1948, patients undergoing cataract eye surgery spent a week in hospital, immobilised with sandbags to support their head.

Now the operation is done in 20 minutes, often in clinics rather than full-blown hospitals, with the patient released on the same day.

Similar revolutions are going on in other areas, allowing care to be shifted away from hospital settings into community clinics.

GPs are also getting in on the act, performing everything from minor skin surgery to vasectomies.

The trend has also spawned the creation of a series of enterprises set up by former NHS staff that are increasingly occupying the middle ground between the big private health firms and NHS providers.

In Eastbourne a nurse and occupational therapist have been running a wound-healing clinic for the past three years.

Many of the patients they see have struggled with their wounds for years, but eight in 10 patients are healed within six weeks.