health and social care act 2012 health and social care act 2012 the health and social care act 2012 (c 7) is an act of the parliament of the united kingdom. it provided 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 primary care trusts (pcts) and strategic health authorities (shas) and transferred between £60 billion and £80 billion of "commissioning", or healthcare funds, from the abolished pcts to several hundred clinical commissioning groups, partly run by the general practitioners (gps) in england. 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 2012united kingdomlong titlean act to establish and make provision about a national health service commissioning board and clinical commissioning groups and to make other provision about the national health service in england; to make provision about public health in the united kingdom; to make provision about regulating health and adult social care services; to make provision about public involvement in health and social care matters, scrutiny of health matters by local authorities and cooperation between local authorities and commissioners of health care services; to make provision about regulating health and social care workers; to establish and make provision about a national institute for health and care excellence; to establish and make provision about a health and social care information centre and to make other provision about information relating to health or social care matters; to abolish certain public bodies involved in health or social care; to make other provision about health care; and for connected purposes.citation7introduced byandrew lansleysecretary of state for healthterritorial extent section 46, 56 (1) and (3), 57, 58, 60, 150 (2) and paragraph 1 of schedule 13, section 214 (1) section 222 (1), sections 230(1) - (4), and (6) and paragraph 53 and 59 of schedule 15, part 7, section 231 (1), (3) and part 2 of schedule 20, section 300, 301, part 12, extend to england, wales, scotland and northern ireland, sections 128-133 extend to england and wales and scotland onlydatesroyal assent27 march 2012status: current legislationhistory of passage through parliamenttext of statute as originally enactedrevised text of statute as amended the proposals are primarily the result of policies of the then secretary of state for health, andrew lansley. writing in the bmj, clive peedell (co-chairman of the nhs consultants association and a consultant clinical oncologist) compared the policies with academic analyses of privatisation and found "evidence that privatisation is an inevitable consequence of many of the policies contained in the health and social care bill". lansley said that claims that the government is attempting to privatise the nhs are "ludicrous scaremongering". the proposals contained in the act were some of the coalition government's most controversial. although mentioned in the conservative party's manifesto in 2010, they were not contained in the conservative–liberal democrat coalition agreement, which mentioned the nhs only to commit the coalition to a real-term funding increase every year. within two months of the election a white paper was published, outlining what the daily telegraph called the "biggest revolution in the nhs since its foundation". the bill was introduced in the house of commons on 19 january 2011. in april 2011 the government announced a "listening exercise", halting the bill's legislative progress until after the may local elections; the "listening exercise" finished by the end of that month. the bill received royal assent on 27 march 2012. background the proposals in the act were not discussed during the 2010 united kingdom general election campaign and were not contained in the conservative–liberal democrat coalition agreement of 20 may 2010, which declared an intention to "stop the top-down reorganisations of the nhs that have got in the way of patient care". however, within two months a white paper outlined what the daily telegraph called the "biggest revolution in the nhs since its foundation". the white paper, equity and excellence: liberating the nhs, was followed in december 2010 by an implementation plan in the form of liberating the nhs: legislative framework and next steps. mckinsey & company who have been influential in the british department of health for many years was heavily involved in the discussions around the bill. the bill was introduced into the house of commons on 19 january 2011 and received its second reading, a vote to approve the general principles of the bill, by 321–235, a majority of 86, on 31 january 2011. white paper the act had implications for the entire english nhs. primary care trusts (pcts) and strategic health authorities (shas) were abolished, with projected redundancy costs of £1 billion for around 21,000 staff. £60 to £80 billion worth of commissioning will be transferred from pcts to several hundred clinical commissioning groups, partly run by gps. around 3,600 facilities owned by pcts and shas would transfer to nhs property services, a limited company owned by the department of health. when the white paper was presented to parliament, the secretary of state for health, andrew lansley, told mps of three key principles: patients at the centre of the nhs changing the emphasis of measurement to clinical outcomes empowering health professionals, in particular gps. the white paper set out a timetable. by april 2012 it proposed to: establish the independent nhs commissioning board establish new local authority health and well-being boards develop monitor as an economic regulator. the bill foresaw all nhs trusts becoming, or being amalgamated into, foundation trusts. the bill also abolished the existing cap on trusts' income from non-nhs sources, which in most cases was previously set at a relatively low single-digit percentage. under the bill's provisions the new commissioning system was expected to be in place by april 2013, at which time shas and pcts would be abolished. the bill was analysed by stephen cragg of doughty street chambers, on behalf of the 38 degrees campaign, who concluded that "effectively, the duty to provide a national health service would be lost if the bill becomes law, and would be replaced by a duty on an unknown number of commissioning consortia with only a duty to make or arrange provision for that section of the population for which it is responsible." it replaces a "duty to provide" with a "duty to promote". "listening exercise" after an increase in opposition pressure, including from both rank-and-file liberal democrats and the british medical association, the government announced a "listening exercise" with critics. on 4 april 2011 the government announced a "pause" in the progress of the bill to allow the government to 'listen, reflect and improve' the proposals. the prime minister, david cameron, said "the status quo is not an option" and many within his and nick clegg's coalition said that certain aspects of the bill, such as the formation of clinical commissioning groups, were not only not open for discussion, but also already too far along the path to completion to be stopped. cameron insisted that the act was part of his "big society" agenda and that it would not alter the fundamental principles of the nhs. part of the "listening exercise" saw the creation on 6 april 2011 of the "nhs future forum". the forum, according to private eye, "brings together 43 hand-picked individuals, many of whom are known as supporters of lansley's approach". at the same time, david cameron set up a separate panel to advise him on the reforms; members of this panel include lord crisp (nhs chief executive 2000–2006), bill moyes (a former head of monitor), and the head of global health systems at mckinsey, as well as mark britnell, the head of health policy at kpmg. six months previously britnell had told a conference of private healthcare executives that "in future, the nhs will be a state insurance provider not a state deliverer," and emphasised the role of lansley's reforms in making this possible: "the nhs will be shown no mercy and the best time to take advantage of this will be in the next couple of years." kpmg issued a press statement on behalf of britnell on 16 may 2011 stating "the article in the observer attributes quotes to me that do not properly reflect discussions held at a private conference last october. nor was i given the opportunity to respond ahead of publication. i worked in the nhs for twenty years and now work alongside it. i have always been a passionate advocate of the nhs and believe that it has a great future. like many other countries throughout the world, the pressure facing healthcare funding and provision are enormous. if the nhs is to change and modernise the public, private and voluntary sectors will all need to play their part." in june 2011 cameron announced that the original deadline of 2013 would no longer be part of the reforms. there would also be changes to the bill to make clear that the main duty of the health regulator, monitor, was to promote the interests of patients rather than promoting competition. the future forum report suggested that any organisation that treats nhs patients, including independent hospitals, should be forced to hold meetings in public and publish minutes. it also wanted the establishment of a citizens' panel to report on how easy it is to choose services, while patients would be given a right to challenge poor treatment. the original bill sought to abolish two tiers of management and hand power to new bodies led by gps, called commissioning consortia, to buy £60 billion a year in treatment. professor steve field, a gp who chaired the forum, said many of the fears the public and medical profession had about the health and social care bill had been "justified" as it contained "insufficient safeguards" against private companies exploiting the nhs. amendments following the completion of the listening exercise, the bill was recommitted to a public bill committee on 21 june 2011. on 7 september, the bill passed the house of commons and received its third reading by 316–251. on 12 october 2011, the bill was approved in principle at second reading in the house of lords by 354–220. an amendment moved by lord owen to commit the most controversial clauses of the bill to a select committee was defeated by 330–262. the bill was subsequently committed to a committee of the whole house for detailed scrutiny. the committee stage was completed on 21 december 2011, and the bill was passed by the lords, with amendments, on 19 march 2012. the commons agreed to all lords amendments to the bill on 20 march 2012. the bill received royal assent and became the health and social care act 2012 on 27 march 2012. contents parts 1 and 2 health service in england section 9 establishes the national health service commissioning board, later known as nhs england. the secretary of state is to publish, annually, a document known as the mandate which specifies the objectives which the board should seek to achieve. national health service (mandate requirements) regulations are published each year to give legal force to the mandate. section 10 establishes clinical commissioning groups which are to arrange the provision of health services in each local area. section 11 makes the protection of public health a duty of the secretary of state, and section 12 makes local authorities responsible for improving the health of the people in their areas. among the effects of this, local authorities regained the commissioning of some community services such as those for sexual health and substance misuse. section 30 requires each local authority to appoint a director of public health, and gives the secretary of state certain powers over that person's appointment. part 5 public involvement and local government sections 181 to 189 establish healthwatch england, responsible for gathering and championing the views of users of health and social care services in order to identify improvements and influence providers' plans. sections 194 to 199 establish health and wellbeing boards in each upper-tier local authority, in order to encourage providers of health and social care to work in an integrated manner. part 8, national institute for health