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The controversial Health and Social Care Act 2012 came in to effect on 1 April 2013, and the reforms have been seen as the most complex and wide-ranging changes to the NHS since its formation in 1948.
The aims include making clinicians, not managers, responsible for designing services, and increasing the involvement of patients in decisions about their care. Ministers also hope to improve quality of care by introducing more competition among providers, and offering patients greater choice.
The scale of the changes can be seen in a calculation by the National Audit Office, showing that while 170 NHS bodies were closed, 240 new organisations were created.
The Department of Health has given up its involvement in the direct, day-to-day management of the NHS, but still oversees the general strategy and provides overall leadership. The new power in the system is NHS England, which now manages the service and is accountable to the DH but can decide how best to meet its annual objectives.
NHS England’s core responsibilities are:
- Oversee the running of the commissioning system as a whole.
- Support, develop and hold to account the new clinical commissioning groups (CCGs).
- Directly commission primary care, prison, military and secure care, and services too specialised to be commissioned on a local basis.
Clinical Commissioning Groups
The Act established 211 clinical commissioning groups (CCGs), which are independent statutory bodies charged with commissioning most of the care that their populations require.
All GP practices have to be a member of their local CCG, and the executive board has to be led by a majority of GPs, alongside managers, lay people and other medical professionals. The aim of these groups is to design and run high quality healthcare services, informed by the needs and wishes of the local population, in the most efficient way possible.
CCGs are responsible for commissioning the following services:
- Children's healthcare
- Community health services
- Continuing healthcare
- Elective hospital care
- Care for people with learning disabilities
- Maternity services
- Mental healthcare
- Older people's healthcare
- Urgent and emergency care
CCGs are also expected to help improve the quality of primary care in their area, and are responsible for setting a prescribing budget for each GP practice.
Commissioning Support Units
There are 18 commissioning support units (CSUs) that were set up to support CCGs in their commissioning functions, for example contract management and the redesign of services.
They are hosted by NHS England but all staff are employed by the NHS Business Services Authority. CSUs are expected to operate on commercial terms and the government expects them to become independent bodies by April 2016, when they will compete in an open market to provide commissioning support to the NHS.
Local authorities and public health
The 152 local authorities have a new responsibility to improve the health of their populations and commission local public health services. They receive ring-fenced funding from the DH for this work, and are supported by a new national body called Public Health England.
Public Health England pulls together public health specialists from more than 70 organisations into a single service, employing more than 5,000 staff, and is responsible for protecting and improving the health of the public.
Health and Wellbeing Boards
Each local authority has established a health and wellbeing board, bringing together key players in the local health and care system, including councillors, patients, CCGs, social services, children’s services, the voluntary sector and public health officials.
The boards will have strategic influence over commissioning decisions across health, public health and social care, and increase the democratic legitimacy of the new system.
They will aim to develop a shared understanding of the health and wellbeing needs of the community, through the Joint Strategic Needs Assessment, and develop a joint strategy for how these needs can be best addressed.
A key aim of the NHS reforms was to increase public involvement in the running of the healthcare system. Healthwatch England has been set up as a statutory committee of healthcare regulator the Care Quality Commission, to ensure the views of patients are heard in the development of national policy and guidance.
Local Healthwatch bodies aim to inform the public and patients about accessing healthcare services and exercising their right to choice, as well as reporting back the views and experiences of patients to Healthwatch England.
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Further reading: A key source for this article was the National Audit Office report on the first months of the NHS reforms: Managing the transition to the reformed health system.
For profiles of all 211 CCGs and each commissioning support unit, visit our commissioning website www.insidecommissioning.co.uk.