Health and Social Care Bill 2011
The Bill aims to reduce the central direction of the NHS, to promote competition in the delivery of health services, to engage doctors in the commissioning of health services, and to give patients greater choice.
The Bill (introduced on 19 January) gives effect to the policies requiring primary legislation set out in the White Paper Equity and Excellence: Liberating the NHS, published in July 2010. It is the largest piece of health legislation since the creation of the NHS and will fundamentally alter the landscape of healthcare in England: abolishing several NHS bodies and layers of management, changing the way NHS services are commissioned and establishing local government powers to promote public health. It contains provisions covering five themes:
- strengthening commissioning of NHS services;
- liberating provision of NHS services (promote competition);
- increasing democratic accountability and public voice;
- strengthening public health services;
- reforming health and care arm's-length bodies.
The power and responsibility for commissioning services is being devolved from Strategic Health Authorities and PCTs to local consortia of GP practices, as part of the government's desire to shift decision-making as close as possible to patients. It gives groups of GP practices financial accountability for the consequences of their decisions.
GP commissioners must open up services to any willing provider, including those from the voluntary and private sectors. The best NHS providers should thrive, as more patients choose to use them, and funding follows those patients' choices. Those providing poorer quality or unresponsive or inefficient services will come under increasing pressure.
The Bill is placing Health and Wellbeing Boards on a statutory footing and ascribing specific new functions to them, in addition to joining-up the NHS, social care, public health and other local services. HWB Boards will be required to lead the development of the local Joint Strategic Needs Assessment (JSNA) to provide a strong information and intelligence system. They will also lead on the development of a Joint Health and Wellbeing Strategy (JHWS). The Bill will place a legal obligation on NHS and local authority commissioners to refer to the JSNA and to have regard to the JHWS in exercising their commissioning functions. The HWB Board must include a member of HealthWatch.
Responsibility for public health leadership will return to local authorities, who will be expected to advise GP Commissioning consortia to inform the commissioning of NHS funded services and facilitate integrated pathways of care for patients. Directors of Public Health will move from the NHS to local authorities. Local authorities will have a new statutory duty to take steps to improve the health of their population and will receive an incentive payment, or 'health premium', dependent on the progress made, based on elements of the Public Health Outcomes Framework.
The Bill seeks to make substantial savings by reducing bureaucracy and reviewing the Department's arm's length bodies. Abolition of PCTs and SHAs and other reforms will reduce NHS management costs by 33%, enabling money to be invested in front-line service to start a cultural shift to a patient-centred NHS.
Read the Health and Social Care Bill
Read the MPs Research Paper
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