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In the fourth and final part of an NHS local discussion held at the new Queen Elizabeth Hospital in Birmingham, a panel and invited audience discussed the impact that changes to the NHS will have on NHS staff. NHS staff are in contact with more than 1.5 million patients and their families every day. While funding for the NHS will be increasing in real terms, in five years time the net increase will be less than half a per cent, so big productivity savings will be needed. The impact on staff at the NHS is likely to be significant, with PCTs and Strategic Health Authorities due to be abolished and big management cost savings being required of hospital trusts. In a debate called 'Liberating the NHS?', which was recorded shortly before the establishment of the NHS Future Forum, a panel of four featuring Ian Cumming, OBE, chief executive of NHS West Midlands, Dr Andrew Coward, chair of the South Birmingham Integrated Care Commissioning consortium, Sue Davis, CBE, chair of Sandwell and West Birmingham Hospitals NHS Trust, and Jenny McCrorie, chair of Cleobury Patients' Voice, were asked questions on the impact of change on health services by NHS local presenter Charlotte Hume. They were joined in the discussion by an invited audience featuring representatives of senior hospital clinicians, patient groups, healthcare workers' unions and doctors and nurses in training.