The Health Act 1999 aimed to improve the quality of care provided to patients by the NHS and made a number of provisions intended to improve the coordination of care between local authorities and the NHS.
The act formally abolished GP fundholding and made provision for the establishment of primary care trusts (PCTs), which would evolve from primary care groups (PCGs). PCGs had been established from 1 April 1999 under existing powers as health authority committees.
The act gave the secretary of state powers to establish PCTs, which would take on the commissioning functions undertaken by health authorities and GP fundholders. The act also gave PCTs powers to directly provide some services and exercise some limited functions in relation to general medical services. It was thought that initially PCTs would only provide community health services or some personal medical and dental services.
PCTs would typically serve a population of at least 100,000 and have a budget of around £60m. PCTs would be accountable to the local health authority and would be subject to directions from the secretary of state.
Flexibilities were also introduced to encourage more effective integration between the NHS and social services departments by allowing the setting up of pooled budgets; ‘lead commissioning’ where either the health or local authority could delegate functions by nominating a lead commissioner; and the integration of service provision covering the provision of both health and social services functions to enable one-stop shop style care services.
The act also established the Commission for Health Improvement (CHI) to:
- provide advice or information on the monitoring and improvement of care quality
- conduct reviews of and make reports on the arrangements set in place by primary care trusts and NHS trusts to monitor and improve care quality
- carry out investigations into and report on the management, provision or quality of health care by health authorities, primary care trusts or NHS trusts
- conduct reviews and report on the management, provision, quality of and access to particular types of healthcare for which NHS bodies or providers were responsible, and other prescribed functions.
The 1999 act allowed the secretary of state to increase initial allocations made to health authorities where certain conditions were satisfied. The intention was to reward those health authorities that made the most progress in implementing plans for improving healthcare. Performance would be assessed against the achievements of targets and objectives set out in local health improvement programmes. The secretary of state was able to attach conditions to additional funding.