parliament of the united kingdom published the health and social care act 2012.
parliament of the united kingdom published the health and social care act 2012.
who published the health and social care act 2012?
parliament of the united kingdom
the health and social care act 2012 (c 7) is an act of the parliament of the united kingdom. it provides for the most extensive reorganisation of the structure of the national health service in england to date. it removed responsibility for the health of citizens from the secretary of state for health, which the post had carried since the inception of the nhs in 1948. it abolished nhs primary care trusts (pcts) and strategic health authorities (shas) and transferred between £60 billion and £80 billion of "commissioning", or health care funds, from the abolished pcts to several hundred "clinical commissioning groups", partly run by the general practitioners (gps) in england but a major point of access for private service providers. a new executive agency of the department of health, public health england, was established under the act on 1 april 2013.
health and social care act 2012
national health service governance has seen three phases of change. while the nhs constitution states patients and staff should be "involved" and "engaged", the actual right of stakeholders to vote has been slow. first, and originally, the nhs act 1946 created a system of 14 regional hospital boards that would pay for staff, buildings and equipment at hospitals, and gave grants to local health authorities in each council which ran health centres overseen by "executive councils". the minister of health (with whitehall civil servants) appointed the regional boards, while executive councils and local health authorities were medical professional representatives (though not necessarily elected), local government and minister appointees. in 1973, regional hospital boards were renamed regional health authorities, and 90 area health authorities plus 205 district health authorities took over from the more numerous local health authorities, while the government aimed to give stakeholders more direct voting rights in all. second, from the nhs and community care act 1990 health authorities had to predict and account for their spending, and contract for their purchases of medical services from nhs trusts, which would compete among one another to sell health services. this did not yet mean that private companies could also compete, although the nhs (private finance) act 1997 enabled the secretary of state to approve "private finance initiative" schemes to borrow money for, or lease, the building and running of health facilities from private contractors (e.g. telereal trillium ltd, innisfree ltd or hsbc infrastructure co ltd). from 1995 to 2006 a new nhs executive was created to manage the nhs in england, but was reabsorbed into the department of health. the executive or department oversaw strategic health authorities (28 reduced to 10), and primary care trusts (303 reduced to 101) which provided health services, and bought or "commissioned" "secondary care" health services (e.g. from a specialist doctor). from 2003, nhs foundation trusts were created, which could borrow money without department of health approval. under the national health service act 2006 schedule 7, its "council of governors" must have a constitution where at least three governors (but under half) must be elected by the foundation trust's employees, at least one by nearby local authorities, one by a university (if any) in the area. a trust's constitution is free to enable residents, employees or patients to vote, although the law does not fix rules. third, instead of enabling nhs foundation trusts to take purchasing in-house, the health and social care act 2012 set up around 200 clinical commissioning groups to replace pcts. ccgs are funded and mediated by nhs england. according to the hsca 2012, a ccg is a "body corporate" that should buy services, with members who can set pay for themselves. a ccg must include at least 6 members (many came from abolished pcts, general practitioners or private business), with one person qualified in accounting or finance, a nurse, a secondary care specialist, and two lay people who understand finance and the local area. two central features of the health and social care act 2012 were that section 75 required commissioning was subjected to competition law (i.e. ccgs are potentially unable to cooperate to bargain down drug company prices, etc.), and section 165 enabled nhs foundation trusts to derive up to 49% of their income from private work. in theory, ccgs are meant not to discriminate, seek the best "value for money" and avoid conflicts of interest when buying services. however, the enforcement of the prohibition on conflicts of interest requires costly judicial review, while derivative claims by patients or staff are excluded without membership. although ccgs are under a duty to "involve" patients and the public in decision-making, those stakeholders can be ignored because unlike in nhs foundation trusts they have no right to vote. the care quality commission and a subordinate healthwatch england network is meant to inspect and maintain standards.
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