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.The BMJ, 2011; 342:d408, Dr Lansley's Monster 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.
The proposals were 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".Clive Peedell, The BMJ, 17 May 2011, Further privatisation is inevitable under the proposed NHS reforms, BMJ 2011; 342:d2996 Lansley said that claims that the government was attempting to privatise the NHS were "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 Daily Telegraph, 9 July 2010, Biggest revolution in the NHS for 60 years The bill was introduced in the House of Commons on 19 January 2011.http://www.parliament.uk, Bill stages – Health and Social Care Bill 2010-11http://www.parliament.uk, Health and Social Care Bill - text of bill as introduced 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. Many of the structures established by this act of Parliament were dismantled by the Health and Care Act 2022.
Background The proposals in the act were not discussed during the 2010 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.Department of Health, Health and Social Care Bill 2011 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.Hansard, HC Deb 31 Jan 2011, cols 700-704
White Paper The act had implications for the entire English NHS. Primary care trusts (PCTs) and strategic health authorities (SHAs) would be abolished, with projected redundancy costs of £1 billion for around 21,000 staff.guardian.co.uk, 19 January 2011, Health and social care bill based on 20,900 NHS redundancies £60 to £80 billion worth of commissioning would 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, stated 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 wellbeing 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.BBC, 6 April 2011, PM seeks to allay fears, but insists change is needed 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. ePolitix.com, published 2011-04-06, accessed 2011-04-06Government to "pause, listen, reflect and improve" NHS reform plans guardian.co.uk, published 2011-04-06, accessed 2011-04-06
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.The Independent, 7 April 2011, Minister: tell us your fears about NHS reforms – but we might not listen 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".Department of Health, 6 April 2011, NHS Future Forum to provide channel for patient and staff opinion The forum, according to Private Eye, "brings together 43 hand-picked individuals, many of whom are known as supporters of Lansley's approach".Private Eye, Issue 1288, "Is anybody listening?", p30 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,Nursing Times, 3 May 2011, Expert panel to advise prime minister on NHS 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."The Observer, 15 May 2011, David Cameron's adviser says health reform is a chance to make big profitsSpinwatch, 9 May 2011, "The NHS will be shown no mercy" says Cameron health adviser KPMG issued a press statement on behalf of Britnell on 16 May 2011 stating
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.HL Deb 12 October 2011, cols 1711-1715 An amendment moved by Lord Owen to commit the most controversial clauses of the bill to a select committee was defeated by 330–262.Ibid, cols 1719-1723 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.Media Centre, "Health and Social Care Bill gains royal assent" , Department of Health, (27 March 2012)
Contents Parts 1 and 2 Health service in England Section 4 introduced, for the first time, a duty of the Secretary of State for Health to reduce health inequalities in access to and outcomes of healthcare among the people of 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 3 Regulation of health and adult social care services Part 4 NHS foundation trusts & NHS trusts Part 5 Public involvement and local government