Health service professionals say it is not clear what the changes will mean for the workforce or patients

Many NHS staff are still in the dark about what the coalition's health reforms will mean, are unconvinced they will improve patient care and worried that cuts to social care will create major problems for the service.

These are some of the key findings of a survey of NHS professionals, in both clinical and management roles, who belong to the Guardian's healthcare network. They show that many of those most directly affected by the government's radical restructuring of the NHS in England do not understand how it will be implemented and fear it will weaken vital parts of the service.

The 605 members of the network who responded to the survey, which was conducted in June and July, include chief executives, service managers and health policy advisers, as well as nurses, health visitors and midwives. Their concerns reflect some of those already articulated by medical groups, health unions, patient charities and organisations such as the British Medical Association and Patients Association.

Asked: "Do you think it is clear how the reforms will be implemented?" a resounding 81.2% said "No"; 8.8% said "Maybe" and just one in 10 said "Yes". Respondents' comments do not constitute a scientific poll of NHS staff's views, but do indicate confusion, serious concern and doubt that the different parts of the new system beginning next April – handing GPs unprecedented power, transferring public health to local councils and creating a new all-powerful NHS Commissioning Board – will fit together easily.

"It still remains very hazy how some aspects of the changes will actually operate, for example, the work of Monitor; the real contribution and effectiveness of HealthWatch groups," said one. Uncertainty about which organisation will do what in the revamped NHS was a recurring theme. "Continuing lack of clarity ref roles and responsibilities"; "There is confusion as to how the reforms will be implemented, particularly with Clinical Commissioning Groups [CCGs]"; and "The new decision-making bodies are still being set up and they seem unclear about how things will work themselves" were among members' comments on that theme. Another said: "Theoretically it makes sense, but in the real world the NHS staff I talk to are worried and confused".

Others also used words like "confused", "muddled" and "concerned". One said that the "specialised commissioning process [has been] paralysed by uncertainty" and another that: "It is totally shambolic for those of us actually working in the system", while another described "a sense of chaos … fear, anger and low morale". One respondent said that the changes to public health were "a mess".

A management consultant confirmed NHS insiders' concerns, saying: "As a management consultant with NHS clients, every day I see clients in a state of confusion about how the reforms will be implemented." Several voiced concern about whether the growing number of private firms offering NHS services will work co-operatively with existing providers. Fragmentation of services is a common worry.

Jamie Reed, the shadow minister for the NHS, said: "If you are spending over £3bn on the biggest change to the NHS since its inception, and are asking staff to implement changes that they can't see either the value or purpose of, there's clearly been a cataclysmic failure of leadership at the very top of the NHS, which points the finger at Andrew Lansley and David Cameron.

"It's not seen as a great idea by NHS staff, not because of a failure of communication but because of a failure of policy."

When Lansley, who was moved in last week's Cabinet reshuffle, was proposing and defending his shakeup throughout the long months of controversy, he insisted – and Cameron agreed – that it would drive up standards of care and ultimately benefit patients.

The respondents to our survey disagree. Asked if they think the reforms will improve outcomes for patients, 58.6% said "No", 33.3% said "Maybe," and just 8.2% agreed. Explaining their answer some respondents cast doubt on GPs' ability to commission health services effectively on behalf of the population of their CCG. "As intellectually able as GPs are, they have not been trained in how to commission and run contracts", said one. An ex-GP said: "I know, but many do not know, what they do not know".

Staff have concerns that the changes, including the creation of CCGs, will lead to longer waiting lists for treatment, an extension of "postcode lottery" access to healthcare and, over time, the emergence of a two-tier health service, all of which – if they happened – would undermine, not enhance, patient outcomes.

Mike Farrar, chief executive of the NHS Confederation, which represents most NHS organisations in England including hospitals, said: "The findings of this survey show there is still uncertainty and concern about how we will work through the NHS reforms, but optimism about what they can achieve. NHS leaders have told us they are concerned about the danger of conflicting policies and bureaucratic burdens arising from new national organisations being created. It is essential that these new bodies listen to the concerns of the health service and drive towards the same goals" – a message aimed at the new NHS board.

Perhaps the most striking, if unsurprising, finding was that 92.9% fear that cuts to social care will have a major impact on the health sector in terms of extra work for NHS staff because of "bed-blocking" – patients being kept in longer than necessary because lack of social care means they cannot return home. That is estimated to cost the NHS £18.5m a month.

On that issue respondents say their place of work is "delaying hospital discharges for social reasons", and that "patients awaiting homecare block acute beds in hospitals".

To Farrar these findings confirm that "our current model of social care is broken and we urgently need a long-term, sustainable resolution to avoid further detrimental impact on local government and NHS services. As part of this we need affordable and coherent decisions about funding. If we do not crack this nut, we risk paying the price further down the line."

More positively, 37.9% are seeing evidence of increased opportunities for integration across public services, though almost as many – 34.9% – are not, with 27.2% "maybe" doing so. These new partnerships are most commonly being explored with patients (44.5%), the voluntary sector (44.3%), social care (41.6%), the private sector (36.4%) and local government (36.1%).

Earl Howe, the health minister, said the findings "cannot be taken as an accurate representation of the current mood from within the health service" because respondents represented only a tiny fraction of the NHS's 1.5 million-strong workforce. "Of course, every important reform to the NHS, under whatever government, has had its critics from within the system," he said. "But this will help to deliver better health, better care and better value for money."