Introduction
The Health and Social Care Act was introduced in April 2012 as part of a series of efforts by the government to reorganise the structure of the National Health Service of England. The Act fundamentally provides autonomy to healthcare providers and abolishes the NHS primary care trusts and strategic health authorities in order to make way for clinical commissioning groups which are controlled more actively by professional practitioners. The purpose of this paper is to critically analyse the changes in the National Health Service after the introduction of the Health and Social Care Act, 2012. This will include the evaluation of the reforms and its impact on the healthcare system of England.
The Health and Social Care Act, 2012 brought about a lot of measures that reorganised care within the National Health Service. These modifications can be viewed from the context of the five different parts of the Act.
Part 1 sets out changes in the health services and the modification of the duties of authoritative figures. This include the definition of the duties of the Secretary of State who was relieved of the direct obligation to provide healthcare within the broader national context. The first part defines the scope of the Clinical Commissioning Groups (CCGs) which replaces the Primary Care Trusts (PCTs).
The first part of the law also modifies the role of the local authorities like counties and metropolitan councils. Part 2 does not change much, but provides limits on marketing the diagnosis of certain immunodeficiency diseases. Part 3 provides for the formation of a monitoring body based on new targets including economic, efficiency, effectiveness and continuous improvement in quality. This modifies the old system which does not make these pointers a priority.
Part 4 of the Act abolishes old intermediaries that helped the public sector to deliver health to the people. And this include the abolishing of Primary Care Trusts (PCTs) and Strategic Health Authorities (SHAs). The fifth part of the Act establishes a committee for quality control and watchdog for health to provide advice to the Secretary of State. This culminates in the formation of 211 independent statutory bodies known as Clinical Commission Group (CCG).
Furthermore, the act requires each GP practice is to join one CCG. The CCG is responsible for commissioning hospital care, mental health services and community services. This arrangement is complemented with the creation of a system for the involvement of stakeholders and representatives in the delivery of healthcare including public, nurses, and hospital doctors who could make inputs.
CCGs are directly responsible for commissioning services they consider appropriate to meeting local needs and they are free to use innovative approaches to meet these needs. The HSA is to promote innovation which includes the use of systems like telemedicine to promote better healthcare delivery processes. This gives the GPs authority to prescribe processes for meeting local health needs and the presentation of the right materials and processes and systems for reducing costs and cutting bureaucracy to the lowest levels. This is meant to promote relevance and focus in order to optimise the utilisation of resources and the delivery of the best quality and level of healthcare processes and services.
Figure 1: Overview of Health and Social Care Structures in HSA 2012
Figure 1 above shows the five levels of arrangements meant to help in the delivery of healthcare under the HSA. This is to include the promotion of healthcare and quality of life through three main routes which have some shared services and unique services at some points. The three main paths for the achievement of healthcare and quality of life include Public Health, the NHS and Adult Social Care.
The Local Authorities were to be the main mechanisms through which Public Health and Adult Social Care is delivered. The CCGs will deliver what the NHS is to do directly within a local GP-led system that integrates stakeholders. The Health and Wellbeing Boards are to provide monitoring and evaluation of direct services and units. This is to be complemented by Local Health Watch units that provide various oversight services.
The monitoring and control system is to culminate in the provision of parameters for Public Health Providers, NHS provider units like the CCGs and Social Care Providers. This will help to provide relevant and direct healthcare to people who need it.
Intentions and Outcomes of the Reforms
An investigation into the intentions and outcomes will have to be done by examining the Health and Social Care bill and its consolidation into a law. In 2010, David Cameron announced that the essence of the Health and Social Care Bill was to promote three things – equity, excellence and liberation for the NHS to deliver services they are required to deliver. The fundamental premise for the argument was that income disparity and poverty were key factors in determining the life expectancy of people in the UK. Evidence showed that there was a 7-year disparity in the life expectancy of the rich and poor people in England.
The main procedure for dealing with this was to integrate major trends and processes that will make the best of resources devoted to healthcare. The benchmark was to reduce the cost of NHS’ operations by a third from 2010 to 2015. This was to promote better utilisation of resources and institute more responsible and relevant measures of running affairs.
The intention is to repeal the “duty to provide” obligation placed on the Secretary of State and allows local authorities to define programmes most relevant to an area. This means there is a process of decentralisation which promotes the highest level of relevance and the empowerment of people with the right knowledge and understanding to give their best. This will help to improve the overall level of healthcare for different procedures that can be used to achieve the best results for classes of stakeholders.
The intention was necessary because the older system came up with mixed and unequal results, but the new system of the Health and Social Care Act was to promote directly relevant services and processes. This was to be further improved and enhanced through the use of statistical methods of collecting information, analysing it and providing services that are relevant and appropriate for specific communities.
The method of measurement applied to clinical outcomes were also by default meant to be changed by the introduction of Health and Social Care Act 2012. The measurement of success is based on the ability to undertake the administration of healthcare at the lowest cost, promoting patient choice and the proactive measures of independent NHS board.
Furthermore, the focus is on the empowerment of health professionals, in particular, GPs. This means there are numerous processes of establishing and independent NHS Commissioning Board. This will be done through the creation of local authority and other monitoring and economic regulators that were missing from the healthcare delivery in the past.
Ultimately, the Secretary of State gets a change in his strategy role. The original obligation from the 1940s when the National Health Service was formed was the “duty to promote”. This was a duty to promote healthcare in a Keynesian framework where the society was to provide 100% welfare and healthcare to all citizens in all situations and contexts. The Health and Social Care Act 2012 was to be modified with the “duty to promote”. Hence, the Secretary of State is tasked with the duty of creating an enabling environment where various local branches and units could be put together to deal with the needs and demands of specific people. This will help to provide important solutions to issues that might come up as and when the time comes.
Evaluation of the Impacts of the HSC Act
The results show that there have been major modifications and changes in the way healthcare has been delivered since 2012. This is because there are many pointers and elements of proactive measures that have been demanded of general practitioners since the 1990s.
Since the HSC Act was introduced, there have been various improvements and enhancements in the delivery healthcare. This is mainly done in the context of an individual approach and a case-by case method of critiquing the needs of classes of patients. Through this, interventions are typically put in place to enhance and improve the process of delivering healthcare in a given facility or groups of facilities.
Usually, there is the move to blend primary and secondary healthcare with public health and this has caused new things like preventive care and exercising to be viewed in the context of educational quality. However, evidence shows that there is limited evidence to show that chronic burden like cancer, dementia and other disabilities of old age are given appropriate attention under the HSA Act, 2012.
In terms of public health, there are many other things that have flourished since the introduction of the HSC Act. This include the use of the Internet and social media as a platform for feedback gathering and the betterment of healthcare. This is because the Internet and social media allows for public participation – sharing experiences on the Internet improves service delivery. Therefore, the introduction of HSC Act, 2012 has created many procedures and features for improved and enhanced healthcare environment and processes.
Conclusion
The current NHS system works through a system of improving the quality of life of people in England. It is one in which the Secretary of State is required to create an environment for the best delivery as opposed to providing healthcare directly. This has led to decentralisation which in turn has caused improvement and enhancement of care by involving general practitioners and the healthcare stakeholders who provide have a lot of say in the delivery of healthcare at specific points in their locality.
The decentralisation of healthcare through the HSA Act, 2012 has also created public health and adult social care units which are under the local authorities and this complements the clinical commissioning group (CCG) of the NHS in providing direct support to relevant service delivery units to achieve optimal results. There are health and wellbeing boards that supervise activities at the local levels. This ensure that there is directing and steering of affairs in order to move things in the right direction. Also, there are Local Watch Groups who provide leadership and supervision to specific providers of services. This enables engagement and dialogue in order to create a system that is coherent and relevant to the local context and also, the necessary controls and checks for the attainment of the highest and best results in all situations and contexts.
All in all, a more efficient, effective and economic system has been put in place under the HSC Act, 2012. Instead of the up-bottom approach where things are imposed on the health services in local zones from the Secretary of State and the ministry, there is more engagement at the local level. The Act promotes more autonomy and this enhances and enriches the healthcare system of all local contexts and processes.
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