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• 24 January 2012               NHS shake-up
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• Is it too late to stop the NHS overhaul?
• Why 2012 is a big year for the NHS
• The overhaul of the NHS in England is hindering its ability to make the savings it needs to safeguard its future, MPs have said.
• The NHS has been told to save £20bn by 2015 through improving productivity.
• But the health select committee said the planned reforms were "complicating" the process because they were acting as a "disruption and distraction".
• Health Secretary Andrew Lansley says his reforms were "essential" for improving the NHS.
• Last week unions representing midwives and nurses joined the BMA in urging the bill behind the changes be scrapped.
• There is mounting concern about the government's plans which will see GPs take control of much of the NHS budget and greater competition encouraged with the private sector.
• Opposition
• On Thursday a meeting of all the royal colleges and unions is being held to discuss the next steps in opposing the changes.

        The health committee report was not specifically looking at the reforms. Instead it focused on how the NHS was doing in achieving the                   efficiency savings it has been asked to make.

• While the health budget is being protected, savings are still having to be made to keep pace with the rising costs associated with the ageing population, cost of new drugs and lifestyle factors, such as obesity.

• There is a growing sense that the critics of the NHS reforms are scenting blood.
• Last year's pause had taken the sting out of the attacks and the bill was well on its way through Parliament when 2011 came to a close.
• But there is now a feeling that momentum is gathering behind those who are against the changes.
• The decision last week by the midwives and nurses to move to "outright opposition" attracted attention - as has this report by MPs.
• Ministers accused the unions of being motivated by the row over pensions.
• But later this week a host of health bodies are meeting to discuss the reforms.
• The majority of them are professional bodies that are focused on standards. So if they come out with a strong rejection of the plans it will get even more difficult for ministers.
• Attention will then turn to the Lib Dems and whether their MPs will block the bill when it returns to the Commons.
• There are no signs of that happening at the moment, but serious questions will start to be asked.
• The concerns of the cross-party group of MPs was first reported by the press on Sunday, ahead of the report's publication.
• The MPs said there were strong concerns about the ability of the NHS to make the savings - the equivalent of 4% a year.
• It said there had been too much emphasis so far on short-term cuts and "salami-slicing", instead of re-thinking the way care is delivered.
• And it argued there needed to be more integration with social care to stop people needing hospital treatment, which tends to be more expensive.
• But it warned that in some ways the opposite was happening as councils were increasingly restricting access to services.
• 'Key pressures'
• John Appleby, chief economist of health think tank the King's Fund, said: "The report should serve as a wake-up call for ministers and the NHS about the magnitude of the task ahead."
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• And Mike Farrar, of the NHS Confederation, which represents NHS managers, agreed.
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• He said there was a lot of "uncertainty" in the NHS at the moment that was dangerous.
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• "The NHS faces a once in a generation financial challenge that is still to be explained properly to the public," he added.
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• Rachael Maskell, of the Unite union, said the report should be the "final nail in the coffin" for the bill.
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• The committee is chaired by Conservative former health secretary Stephen Dorrell, who said: "The fact that there is another bill going through Parliament changing the management structure of the NHS means that there is a tendency for every comment about the NHS to be framed by the debate about the bill.
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• "But the NHS is well used to management change. In reality, the key pressures which are building in the system arise from the fact that demand is continuing to grow at a time when health and social care budgets have stopped growing."
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• Mr Lansley said the government's plans for modernisation "are essential if we are to put the NHS on a sustainable footing for the future"