This really must not be any substitute for proper investment in the NHS

Mike Stone

Mike Stone, chief executive of the Patients' Association, told BBC Breakfast: "The worrying thing about this, without a doubt, is that you could end up with a many tiered system in the NHS where the good hospitals get better and the bad hospitals won't be getting the attention that they need to improve themselves.

"This really must not be any substitute for proper investment in the NHS, to make the whole of the NHS better."

Panicking

You can understand that the government feels under pressure to make improvements, but it needs to hold its nerve

Bob Abberley

Bob Abberley, assistant general secretary of the biggest health service union Unison and a member of the NHS Modernisation Board, accused the government of panicking.

He said the NHS Plan was still being rolled out and it was inevitable that it would take time for improvements to become apparent. However, that was no reason to dream up a whole new raft of reforms.

"You can understand that the government feels under pressure to make improvements, but it needs to hold its nerve," Mr Abberley said.

David Hinchliffe attacked the plans

"We need to remember that these successful hospitals have become successful under the NHS, so why do we need to change their status when they are being successful?"

Dave Prentis, general secretary of the huge Unison union, said Mr Milburn's plans were "just another diversion".

"What is needed is more money and investment going into the NHS and the staff who provide the services," he said.

"The health secretary talks about freedom for managers. What does that freedom mean?

"Is it freedom to double their salaries at the patients' expense; freedom to drive down the pay and conditions of staff?"

Health committee

I am finding it increasingly difficult to differentiate between my own government's health policies and those of the previous Conservative government

David Hinchliffe

Mr Hinchliffe said moves to give private managers "franchises" to take over failing hospitals were "incredibly worrying".

He said: "I think we have learned nothing from the previous government. We are increasingly following the same policies."

"I am finding it increasingly difficult to differentiate between my own government's health policies and those of the previous Conservative government."

Mr Hinchliffe said previous Tory attempts to introduce private sector management into the NHS had been a "complete disaster".

"Bearing in mind these past experiences and the more recent example of the consequences of allowing private companies to run the railways I would have expected the government to be going in a very different direction."

Nurses unsure

Dr Beverly Malone, general secretary of the Royal College of Nursing said Mr Milburn's plans appeared to amount to a "pick and mix" approach to running the health service.

Dr Beverly Malone is concerned about accountability

The plans would make it unclear who was in charge and accountable.

She said: "This announcement is likely to lead to increased bureaucracy rather than streamlining already complex structures.

'The RCN questions whether the private sector has the necessary expertise to run large scale NHS hospitals, an area in which they have no previous experience.

"With the variety of providers suggested we need to have guarantees of quality, accountability, transparency and patient involvement."

Doctors' response

Professor Sir George Alberti, president of the Royal College of Physicians, welcomed many of the proposals.

There has been a great deal of frustration about the number of central initiatives and the difficulty of meeting so many objectives

Stuart Marples

He said: "The issue for us is not so much who runs hospitals and Trusts, providing they are efficient, cost-effective and produce high quality care for patients.

"Physicians can have a much bigger role than at present in these processes.

"In the short-term, whatever management system we use there will continue to be problems while we build up the number of doctors, nurses, and other professionals, bed numbers and diagnostic and treatment facilities. There are no quick fixes."

Dr Ian Bogle said national conditions must remain

Dr Ian Bogle, chairman of the British Medical Association, said the reforms were good news - if they lead to raised standards in hospitals.

"Doctors and managers could be given more freedom to make decisions, free from excessive interference, and meet the needs of local people.

"However, there are certain features of the current NHS that we would wish to see preserved.

"The drive for high quality, national and uniform standards of care and external monitoring should continue.

"National terms and conditions for doctors should be safeguarded."

Managers' view

Stuart Marples, chief executive of the Institute of Healthcare Management, said it was high time to end central control in the NHS.

He said: "There has been a great deal of frustration about the number of central initiatives and the difficulty of meeting so many objectives.

"If this promised freedom releases managerial innovation it will be a good thing."

Mr Marples said his members were not concerned by plans to import management into failing trusts.

He said: "What is important to all managers, whether they come from the public or private sector or indeed whatever their background, is that the best interests of the patient is being served."

Nigel Edwards, acting chief executive of the NHS Confederation, called on ministers to go further and liberate the whole NHS from Whitehall.

He said: "The government will need the courage of its convictions - history tells us that politicians set out such intentions to free up the NHS but quickly get nervous and fail to provide the necessary freedoms e.g. borrow money, retain reserves, take risks and be entrepreneurial, and to determine local pay."