Health and Social Care Act 2012, Changes to ... - Voice & Influence

Health and Social Care Act 2012,Changes to the NHS.Overview.The stated key aims of the Act are to:-• Improve the quality of health services by promoting ‘autonomy’ (independence).The Act says, (Section 5), that those delivering health care should be:-“free to exercise those functions or provide those services in the manner that itconsiders most appropriate, and that unnecessary burdens are not imposed onany such person.” (As long as their acts are consistent with the interests of the healthservice.)• To reduce health inequalities, for the first time the Secretary of State for Healthhas a duty to tackle this issue.• To promote public health and promote the quality of health delivery by improvededucation and research in health.The legislation is massive, covering 454 pages; this short outline will focus on the mainchanges particularly those at a local level, in respect of commissioning and delivery ofhealth care. The changes come into force in April 2013.The National structure.At a national level much of the Department of Health continues to run as before, somenew agencies are created to support local change. The most significant change iscreation of the NHS Commissioning Board. Regarding commissioning arrangements,in simple terms:-Ministers develop annual ‘mandate’NHS Commissioning Board (involvement of Public Health England and other agencies)NHS Commissioning Board, local level(commissioning someservices directly - GP’s, dentists, pharmacists, specialised services and offender health)Local Clinical Commissioning Groups – commissionlocal health servicesDepartment for Health. The Secretary for State for Health is Jeremy Hunt. TheDepartment is still responsible for health and social care matters, including the NHS. TheNational Institute for Care Excellence (NICE), and the Care Quality Commission andmany other agencies remain.1

GP Practices. They are run as independent organisations, their services are currentlycommissioned by PCTs. The main changes after 2013 are that GP services will becommissioned by the National Commissioning Board, and that GP’s though the localClinical Commissioning Groups will be in control of local commissioning of healthservices.What are expected to be the benefits of the changes?• To develop local control of health service delivery. The creation of ClinicalCommissioning Groups may achieve this. Local control and accountability is seenby the Government as a driver of improved quality and innovative service delivery.• Closer links between health and social care. Health and Wellbeing Boards areset up and supported by Local Authorities, set a joint health and wellbeingstrategy, and have power to oversee and encourage joint working.• More focus on public health. The creation of Public Health England, and aspecific duty on the Secretary of State for Health to reduce health inequalities.• Hospitals to be more responsible for their own financial and strategicmanagement. Achieved by the continued development of NHS Foundation Trusts.• More patient and public say on health services. Achieved by a legal duty onClinical Commissioners to have patient and public involvement strategies, to drivetheir commissioning activities, so improving services, and the introduction ofHealthwatch.• Quality NHS services. Local commissioning may lead to more creative, morelocalised and better quality health delivery, with a strong link between whathappens in GP surgeries and the commissioning of health care.What are the criticisms of the changes?• They are too large and there is too much uncertainty to ensure quality ofservices over the transition period. The argument regarding local autonomy is lostwith the creation of new national overseeing bodies such as NHS TrustDevelopment Authority and the role of the NHS Commissioning Board that willhave a regional structure and be responsible for some commissioning functions.• There is a lack of guidance about how all the different bodies relate to eachother, with a raft of secondary legislation being developed to plug the gap, creatinga more bureaucratic system than before.• The changes will be very costly, at a time when the NHS needs to find savingsto cover inflation costs and increased demand for services.• That Clinical Commissioners, elected GP’s, and other health professionals willlack commissioning expertise at the required level, so will simply take on existingstaff of PCTs to do the work, and not exercise their control and local influences.This paper is an overview of the main structural changes, and must not be taken as a definitiveguide to the Health & Social Care Act 2012.A series of factsheets are available from the Department of Health on the changes:-http://www.dh.gov.uk/health/2012/02/bill-factsheets/. For updates and general information:-http://www.nacva.org/uk/hscInformation sources:- Department of Health, The Kings Fund, NHS Commissioning Board, NHS Bristol, Monitor,Bristol City Council, The Guardian.Dated September 2012.4