Health and Social Care Act
The Health and Social Care Act 2012 is one of the most complex pieces of legislation ever introduced – and for that reason – one of the most under-reported by the media and least understood by a broader public. The profound changes that the act introduces have been described the NHS Chief Executive as “so large you can see them from space”. In effect the act is a vast legislative experiment being performed on one of our most important public services we have, with indefinable consequences for the health of the nation.The same act also removes the Secretary of State for Health as being responsible to parliament for the provision of a comprehensive health service. This gives rise to a troubling lack of accountability at the top for the changes now taking place.
What did the Health & Social Care Act actually do?
The Health and Social Care Act 20121 did 3 main things:
- Removed the responsibility of the Secretary of State to secure comprehensive and universal healthcare provision. This means government can blame local decision makers (Clinical Commissioning Groups and NHS hospitals), and that these organisations will find it easier to start to withdraw care from patients and/or start charging for it.
- Lifted the cap on private patient income from Foundation Trusts (and laid down a legal requirement for all NHS Trusts to become Foundation Trusts), so that they can earn up to half their income from patients who can afford to pay (meaning those of us who can’t, will be increasingly pushed to the back of the queue).
- Replaced the old bureaucracy with a new, more complicated one (at a cost of £3bn), in particular replacing Primary Care Trusts with Clinical Commissioning Groups (CCGs). CCGs have less responsibility to treat all patients intheir areas. They have a few doctors on the board (this is why the Act was presented as ‘giving power to doctors’, even though most doctors are not involved and want to spend their time being doctors, not contract administrators).
Just before the Act went fully ‘live’ in April 2012, a regulation (under Section 75) was inserted doing one more, crucial thing:
- Requiring all commissioning decisions to be open to competition from private providers, unless there is only ‘one capable provider’ (something that is very hard to prove, particularly when there is continual talk of the need to ‘do things differently’).
The effect of all of this will be to hasten privatisation of the NHS . In the longer term, there are also fears about the impact of a forthcoming EU/US Free Trade Agreement making it more difficult to regulate private providers or undo privatisation.
The three main ways that privatisation of our NHS is taking place
taken from KONP – see full document>>>
- By putting a contract ‘out to tender’ so that private companies can bid (a
cumbersome process that they can afford teams of experts to undertake
- By using the new ‘Any Qualified Provider’ (AQP) model which means private
companies get onto a ‘shopping list’ of providers which the patient then chooses
from. This model gives CCGs very little control – but it is cheaper
- By the use of direct payments and/or ‘personal budgets’ for an increasing range of
conditions – patients are given a fixed sum to buy their healthcare themselves, from
either the NHS or private providers. Personal budgets have been trialled since 2009
and are now being rapidly extended. By 2014 they will be rolled out to all patients
receiving NHS continuing care. The experience from social care personal budgets
here and healthcare in other countries is that risk is passed down to the patient, and
state health providers can go under. Budgets often get progressively cut, leaving
the individual to top up from their own pocket, or via insurance, if they can afford it