National Health Service Reform and Health Care Professions Act 2002

The NHS Reform and Health Care Professions Act 2002 received royal assent on 25 June 2002. It legislated for recommendations made in light of the Bristol inquiry and government proposals in the 2001 document Shifting the balance of power within the NHS.

The reform programme (established by the Act and an earlier legislative order) amended the structural framework for health services in England by abolishing the 95 health authorities, delegating most of their functions to primary care trusts (PCTs) and creating 28 new strategic health authorities (SHAs).

Amending the structural framework

SHAs were larger authorities, serving a population of between 1.2–2.7 million, which would have a performance management role. They were the main link between the Department of Health and the NHS at a local level. The Act required the secretary of state to establish both SHAs for the whole of England, as well as PCTs to cover all areas in England.

The Act strengthened the independence of the Commission for Health Improvement (CHI) and required it to make an annual report on the quality of NHS services, as well as providing for it to:

  • inspect and report on services
  • recommend special measures in cases of poor-quality or failing care
  • appoint its own chief executive.

Independent patient forums

The Act also provided for the creation of an independent patients' forum for every NHS trust and PCT in England, which could monitor, inspect and provide representation on behalf of the public. The duty to involve the public had been enshrined in the Health and Social Care Act 2001.

In 2003, 572 patient forums were set up and supported by the Commission for Patient and Public Involvement in Health (CPPIH), which would report to the secretary of state on the effectiveness of patient and public involvement and would set standards for patient forums. Community health councils were abolished and Patient and Public Involvement Forums (PPIFs) took over their inspection function and patient and public representation role.

Unlike their predecessors, the remit of PPIFs included primary care. However, social care services were not included. PPIFs possessed several statutory powers, which included right of access to healthcare premises, ability to request information from trusts and PCTs (which had a corresponding duty to respond) and the power to refer issues of concern to local authority Overview and Scrutiny Committees.

Oversight and reporting

The Act also created the Council for the Regulation of Health Care Professionals (renamed the Council for Healthcare Regulatory Excellence (CHRE) in September 2004) to oversee the activities of different regulatory bodies of the health care professions, which included the coordination of good practice guidance. The Act gave the council powers to refer a fitness to practice decision by a regulatory body to the High Court, where this was in the interest of the public.

The council had a range of powers, which included:

  • investigating and reporting on the performance of the regulatory bodies it oversaw
  • reporting to Parliament on how each body had promoted the health, safety and wellbeing of the public
  • advising ministers.

Later developments

On 1 July 2006, the number of SHAs was reduced to 10. SHAs were eventually abolished by the Health and Social Care Act 2012.

CPPIH, set up in January 2003, did not have much time to establish itself before a ministerial decision was made in July 2004 to abolish it. Following five reviews of the date of abolition, a Department of Health review into its arms-length bodies, and the enactment of the Local Government and Public Involvement in Health Act 2008, the CPPIH formally ceased to exercise its statutory functions in March 2008. Forums were replaced by local involvement networks (LINks).

CHRE was renamed the Professional Standards Authority under the Health and Social Care Act in 2012. The statutory regulatory bodies for the health professions regulated by the CHRE included:

  • The General Medical Council
  • The General Dental Council
  • The General Optical Council
  • The General Osteopathic Council
  • The General Chiropractic Council
  • The Royal Pharmaceutical Society of Great Britain (later General Pharmaceutical Council)
  • The Royal Pharmaceutical Society of Northern Ireland (later the Pharmaceutical Society of Northern Ireland)
  • The United Kingdom Central Council for Nursing, Midwifery and Health Visiting (later the Nursing and Midwifery Council)
  • The Council of Professions Supplementary to Medicine (later the Health Professions Council).

National Health Service Reform and Health Care Professions Act 2002.

Commission for Patient and Public Involvement in Health.
Report and accounts.
HMSO; 2008.

Department of Health.
The Council for Healthcare Regulatory Excellence (CHRE) Draft Regulations 2008: a paper for consultation.
Department of Health; 2008.