Policy environment: Health and Social Care Bill

The current UK coalition government have now passed the Health and Social Care Act 2012, which dramatically reshape the future roles of the Department of Health and the NHS, including the way in which Public Health services are provided. On this page we describe this process of change, and will provide updates as new plans and processes are announced. At this time of rapid change, all stakeholders are recommended to check the Department of Health's Modernisation of Health and Care webpages regularly, as these provide up-to-date, plain language summaries of policy developments, suggestions for reform, and government responses. In addition, The Lancet oversees a new website called UK Policy Matters that provides plain language summaries of reviews of evidence about health policy impact. Stakeholders are invited to share their own examples of evidence of health policy impact, which will be assessed for inclusion on that site.

For more than a decade the NHS in England has been structured by 10 Strategic Health Authorities (SHAs) that oversee the activities of about 150 Primary Care Trusts (PCTs). SHAs have been responsible for developing plans to improve local health services, ensuring that local NHS organisations are performing well, increasing capacity, and making sure that national priorities are delivered at a local level. For the time being, SHAs are responsible for performance management of NHS services in their area.

Under the current system, SHAs require awareness of the strategic plans and patterns of commissioning and service delivery by the PCTs in their area. Prioritising (local) HIV prevention requires transparent monitoring of spending and activity as distinct from general sexual health spending and investment in clinical services.

This government's reframing of health provision was first set out in Equity and excellence: Liberating the NHS (2010), which describes a Department of Health that aims to:

  • put patients at the heart of everything the NHS does;
  • focus on continuously improving health outcomes; and
  • encourage clinicians to innovate, with the freedom to focus on improved services.

There was a wide-ranging consultation undertaken at the time, including questions about the practical functioning of GP consortia for NHS commissioning. Documentation relating to that consultation, as well as responses and related fact-sheets can be found here.

Another key component of the NHS restructuring proposals was outlined in the government's public health White Paper, Healthy Lives, Healthy People (2010). Central to these proposals was the development of a new public health service, called Public Health England (PHE). PHE will be responsible for improvements in public health, working closely with Local Authorities and other partners. PHE and Local Authorities will jointly appoint directors of public health who will be responsible for safeguarding and improving the health of their local populations. In April 2012 PHE is expected to begin to absorb the functions of the Health Protection Agency, the National Treatment Agency, and the regional and specialist Public Health Observatories. At a local level, transition activities will lead up to formal transfers of public health powers to Local Authorities by April 2013.

In June 2011, following several months of extended consultation, the NHS Future Forum released a set of recommendations to government about what they regard to be necessary changes to the government's plans. Within a week the government gave a full response to the Future Forum's recommendations, setting out how they plan to proceed with commissioning arrangements. They announced that Primary Care Trusts will cease to exist in April 2013, with interim measures in place for areas where commissioning consortia are not in place.

In July 2011 an update and timeline of implementation for Healthy Lives, Healthy People offered the government's response to issues raised during the consultation, and spells out further details about the process. That document confirms the government's intention that HIV treatment will continued to be commissioned nationally by the NHS Commissioning Board, while the responsibility for commissioning comprehensive sexual health services (including sexual health promotion and screening) will be transferred to Local Authorities.

In December 2011, further details about how the new Public Health system will function at national and local levels were made available in the New Public Health System Summary. At the same time, other relevant public health planning documents were made available on the Department of Health's Modernisation of Health and Care webpages.

In January 2012, the Department of Health and the Local Government Association published a guidance document, Public Health Transition Planning Support for Primary Care Trusts and Local Authorities. This offers guidance to relevant bodies on their new public health roles, gives further clarity on the roles of the NHS Commissioning Board, Local Authorities, and Public Health England, as well as outlining key elements of the transition plan.

March 2012: Healthwatch is envisaged by the Department of Health to be ‘the new consumer champion for both health and social care'. It will exist in two distinct forms – local Healthwatch, at local level, and Healthwatch England, at national level. The intention is that it will collate evidence of public and service users' views and experiences in order to better influence planning, commissioning and delivery of health and social care. The aim of local Healthwatch will be to give citizens and communities a stronger voice to influence and challenge how health and social care services are provided within their locality. The Health and Social Care Act 2012 sets out that local Healthwatch will be established in April 2013. Until then Local Involvement Networks (LINks) will continue to operate as usual. In March 2012, there was a useful independent report released, called Shaping Health Watch, which documents work with 9 local authorities to help them consider and plan their arrangements in regard to their duty to commission  the  new Local Healthwatch organisations that are being created throughout England. Updates on Healthwatch developments can be found on the DH website, Knowledge Hub, LINks Exchange and the CQC website

March 2012: The potential impact of the proposed Health and Social Care Bill on HIV / AIDS programmes was debated in the House of Lords on 21st March 2012.

April 2012: Shadow Health and Well Being Boards are implemented, with an aim to work towards transition into full statutory power in April 2013. Health and Well Being Boards will have strategic influence over commissioning decisions across health, public health and social care. The goal is for these boards to provide a greater role for integrated planning and commissioning across public health and social care at the local authority level. Local HIV service providers are strongly encouraged to seek out and establish contact with members of their Shadow Health and Well Being Board now, during this period of transition. The Department of Health has provided a summary of the role of the boards on their website, and is also undertaking a consultation exercise in June 2012, seeking input from a range of experts to determine what the statutory powers of the local Health and Well Being Boards should be.

July 2012: The NHS Commisisoning Board, released a Commissioning fact sheet for clinical commissioning groups that was intended to clarify what will to be commissioned by clinical commissioning groups (CCGs) from April 2013, and the complementary services to be commissioned by the NHS Commissioning Board (NHS CB), local authorities and Public Health England (PHE). We have tried to come to terms with what this means for sexual health in the new commissioning structure but it is complex. Our assumptions about what the new proposals mean for what will be commissioned where are below.

NHS Commissioning Board (national)

  • HIV treatment
  • Contraceptive services commissioned through GP contract
  • Public health care for people in prison and other places of detention
  • Immunisation programmes
  • National screening programmes
  • Sexual assault referral centres

Public Health England (national)

  • Social marketing and behaviour change campaigns including campaigns to prompt early diagnosis via awareness of symptoms
  • Health improvement support for local authorities and NHS CB
  • Public oversight of prevention and control, including co-ordination of outbreak management (with supporting role for local authorities)

Local authorities

  • Testing and treatment of sexually transmitted infections (excluding HIV treatment)
  • Sexual health advice, prevention and promotion
  • Contraception over and above GP contract

Clinical Care Group Commissioning (local)

  • Services for people with learning disabilities
  • Mental health services (including psychological therapies)
  • Infertility services
  • Termination of pregnancy services (with consultation on longer-term arrangements)
  • Sterilisation and vasectomy services
  • Promotion of opportunistic testing and treatment