Structural changes from Health and Social Care Act (2012)
The Health and Social Care Act 2012 came substantively into force on 1 April 2013, bringing about a wide range of structural changes that would impact on the NHS, public health and adult social care.
Strategic health authorities (SHAs) and primary care trusts (PCTs) were abolished, with responsibility for NHS commissioning passing to NHS England at a national level and clinical commissioning groups (CCGs) at a local level. Local authorities took over control of health improvement functions and Public Health England was established as a national body to oversee health improvement and health protection.
Clinical commissioning groups (CCGs)
211 CCGs were established to replace 152 PCTs and commission urgent and emergency care, elective hospital care, community services, mental health services and maternity services. CCGs would be made of GP practices, but to ensure that a broad range of healthcare perspectives are taken into account, they would seek advice from a range of other healthcare professionals.
NHS England was established to oversee the operation of CCGs and allocate funding to them.
CCGs would control the majority of the overall NHS budget, with specialised services commissioned by NHS England, and health improvement services commissioned by local authorities.
Clinical senates were established to provide strategic advice to CCGs, health and wellbeing boards and NHS England on commissioning and decision making on healthcare for local populations. 12 senates were established in England, comprised of a core Clinical Senate Council (a small steering group) and a Clinical Assembly or Forum (a multi-professional group providing support and expertise to the Council). Members include health and care professionals and experts, voluntary sector and patient representative groups.
19 commissioning support units (CSUs) were set up to provide commissioning support services to CCGs, acute trusts, local government and NHS England. These would provide services such as contract management, information governance, financial management, human resources, IT and communications.
Monitor took on its new functions as the sector regulator for the NHS with functions that included:
- running a system of licensing of providers of NHS services
- setting and enforcing requirements to secure continued provision of NHS services
- regulating prices for NHS services through a national tariff, in conjunction with the NHS Commissioning Board
- securing continuity of NHS services provided by companies through a process of 'special administration' and establishing funding mechanisms, to enable trust special administrators to secure continued access to NHS services
- establishing funding mechanisms.
The Cooperation and Competition Panel, which investigated breaches of competition law, became part of Monitor which was given concurrent powers with the Office of Fair Trading with regard to NHS merger decisions.
Public Health England
Public Health England (PHE) was created as an executive agency of the Department of Health. It was given operational independence, but ministers would set its strategic objectives and its functions would be conferred directly on the secretary of state for health by the Health and Social Care Act 2012.
PHE brought together a range of public health functions previously carried out by the Health Protection Agency, the National Treatment Agency, public health observatories, cancer registries and strategic health authorities. It would be responsible for discharging the secretary of state's duty to protect the health of the public, through securing the improvement of the public's health and improving population health through the provision of sustainable health and care services. It would also have a role in ensuring that the capacity and capability of the public health system was maintained, including through supporting local government with their public health duties.
Health and wellbeing boards
Health and wellbeing boards were established by the Health and Social Care Act 2012, to facilitate joint working across health and social care organisations. The boards would also be responsible for producing joint strategic needs assessments and joint health and wellbeing strategies. The Act specified a number of statutory members, including the director of adult social services and director of public health. Additionally, the Act placed a duty on health and wellbeing boards to encourage integration between health and social care commissioners for the benefit of the health and wellbeing of the local population.
Healthwatch England was established to act as an independent consumer champion for health and social care service users and to support the local Healthwatch network. It would be responsible for representing the public's views to national bodies, such as NHS England, Monitor, the Care and Quality Commission and the Secretary of State for Health. Its main functions would include supporting local Healthwatch organisations, collecting and collating national information, and charting trends to discern issues of concern and nationally championing these issues for service users and patients.
Local Healthwatch organisations were established in every local authority area to take over the work of previous local information networks (LINks). They would provide advice, promote choice and signpost individuals, carers and community groups. They would also have the ability to influence local commissioning decisions, through their statutory seats on health and wellbeing boards.
Part of their remit would be to gather information on local people's experiences of health and social care and feed that data into Healthwatch England, which would use the information to influence national policy. They were also given powers to enter and view services. Some local Healthwatch organisations would also be commissioned by their local authority to provide NHS complaints advocacy services.
The National Institute for Clinical Excellence (NICE)
The National Institute for Clinical Excellence (NICE) was given responsibility for developing guidance and quality standards for social care, using its evidence-based model. This was intended to promote better integration between health services, care services and public health. NICE confirmed that it intended to develop quality standards on the following areas related to social care:
- challenging behaviour in people with learning disability
- home care
- managing medicines in care homes
- mental health problems in people with learning disability
- social care of older people with multiple long-term conditions
- transition between health and social care
- transition from children's to adults' services.
Health and Social Care Act 2012.
Get in on the act - Health and Social Care Act 2012.
Local Government Association; 2012.
Understanding the new NHS.
NHS England; 2014.
Public Health England remit letter.
Department of Health; 2014.
What we do.
Healthwatch marks network launch across five events in England simultaneously.
East Sussex Strategic Partnership.
Overview of local Healthwatch functions.
East Sussex Strategic Partnership; 2013.
Further Commissioning Support Unit (CSU) managing directors announced by the Board Authority.
NHS England; 2012.
NHS Commissioning Board.
Developing commissioning support - towards service excellence.
NHS Commissioning Board; 2012.
NHS Commissioning Board.
Clinical Senates update.
NHS Commissioning Board; 2013.
National Institute for Health and Care Excellence.
National Institute for Health and Care Excellence; 2019.
NHS structures and integration.