The implementation of the new Health and Social Care System in England Alan Glasper Introduction commissioning groups around England and dignity they deserve. The new became responsible for the provision of local bodies will work together with the On April 1st 2013 the new health healthcare services. If junior doctors have Department to achieve this common and care system was implemented in poor knowledge about health politics aim of changing health and care for the England. It is envisaged that the new and NHS reforms, then this simple guide better. To ensure that the new system is system will deliver the governments aims to the reforms may prove invaluable to accountable, the Department of Health for health and social care as detailed in both patients and the staff who care for will set objectives and budgets and hold the contentious Health and Social Care them! the system to account on behalf of the Act (Gabbay 2012). As part of these Secretary of State for health who has the reforms NHS England, Public Health The implementation of the ultimate responsibility for ensuring the England, the NHS Trust Development changes whole system works together to meet Authority and Health Education England the needs of patients and the public and that they are enabled to reflect their have commenced their new duties and At its simplest level newly created local experiences through Healthwatch . range of responsibilities. To help explain clinical commissioning groups which are the complexities of the new system the made up of doctors, nurses and other government has produced a booklet professionals can purchase appropriate The impact of the new changes for members of the public which is services for patients, while local councils on patients and their local intended to provide a simple guide to formally take on their new roles in communities. the care system. (https://www.gov.uk/ promoting public health. As part of this government/publications/the-health- change to services, new health and In reality most people will not be and-care-system-explained/the-health- wellbeing boards will bring together local aware of any immediate differences in and-care-system-explained) organizations’ to work in partnership and how they access or receive care as the Healthwatch which has replaced LinKs general practitioner (GP) will remains The whole structure of the new health (the old health care consumer system) the gatekeeper to services. It will be and care system is predicated on the will provide a powerful voice for patients the GP who they will contact when they governments mantra “of no decision and local communities. are unwell and this service remains free about you without you” at the point of delivery as it has in the The production of this booklet is timely Healthwatch England is the new past. However there are some important as the complexities of the changes to independent consumer watchdog for underlying changes that are being made health and care is poorly understood. health and social care in England and it as to how the health and care system This is manifest through a survey of 102 now interacts with a network of 152 local is operated. Primarily these changes junior doctors conducted by Palazzo and Healthwatch organizations to ensure that involve enabling patients and their local Chehab (2013) who found that 63.7% the voices of consumers and those who communities to have a greater say and self-reported poor understanding of use services are fully heard. input into the services they receive. The the NHS reforms and 90.2% felt they new service will also give health care would value formal education on the http://www.healthwatch.co.uk/about-us professionals more autonomy in how to current changes. Additionally 71.6% of resource and configure local health and the junior doctors did not know that The role of the Department of care services to improve the quality of following the rollout of the Health and Health the support, care and treatment local Social Care Act on April 1st 2013, clinical communities receive. This will include The English Department of Health’s for example: primary role is to reduce morbidity and premature mortality among its citizens. •Giving doctors, nurses and other Dr. Alan Glasper is Professor of The department’s role is to directly health and care professionals greater Children’s and Young People’s lead, shape and fund health and care in direct control over planning and Nursing within the Faculty of England, to ensure that people have the commissioning of services to enable Health Sciences at the University appropriate support, care and treatment them to improve the local parameters of Southampton. they need and in light of the events at of health and care including giving Mid Staffordshire NHS Foundation Trust enhanced information on what kind delivered with the compassion, respect of support, care and treatment is Working Papers in Health Sciences 1:3 Spring 1 available locally to the population. patients and communities a strong the healthcare workforce has the •Placing greater emphasis on health voice in decisions that affect them. right toolkit of skills and the training promotion and health education to Local healthwatch will report their to improve the care patients receive prevent illness and to help people views and concerns to Healthwatch wherever and whenever they need stay more independent in older age England so that issues can also be it. HEE is now supporting a network or in living with disability. The recent raised at a national level. of 13 Local Education and Training outbreak of measles in Wales caused •Under the new arrangements local Boards (LETB’s) that are planning the by a fall in herd immunity because authorities can commission care and education and training of tomorrow’s of low uptake of MMR immunization support services and they also have workforce to meet local and national among children is a timely but a new responsibility to protect and needs. LETB boards, which are tragic reminder of this crucial role. ( improve health and wellbeing of their committees of HEE, are made up of http://www.bbc.co.uk/news/health- communities. They will be able to use representatives from local providers of 22277186) this knowledge of their communities NHS services and cover the whole of •Devolving more power to local groups to tackle challenges such as smoking, England. and organizations to ensure that their alcohol and drug misuse and obesity. •The National Institute for Health communities have more influence Working together with health and and Care Excellence (NICE) provides than ever they had in the past in care providers, community groups and guidance to help health and social care deciding how local health services can other agencies, they will prevent ill professionals deliver the best possible be enabled to better support them. health by encouraging people to live care for patients based on the best •Expanding the range of health healthier lives. available evidence. care providers available to health Health and care organizations working •The National Institute for Health consumers by including independent together nationally Research (NIHR) and its clinical research and charitable organizations. This •NHS England is designed to support networks form a health research is designed to offer more choice for the NHS services nationally and to system in which the NHS supports and patients and apply greater pressure ensure that money spent on NHS promotes excellence in cutting edge on existing services to constantly services provides the best possible research. Clinical academic facilities improve. care for patients. NHS England will such as that developed by the Faculty Health and care organizations working fund the local clinical commissioning of Health Sciences at the University locally together. groups to commission services for of Southampton are pioneering the Principally it is the building of Clinical their communities and importantly research role of the nursing academic Commissioning Groups (CCGs) made to ensure that they do this effectively, and the academic in practice. up of doctors, nurses and other health efficiently and economically. •The Health and Social Care Information care professionals who use their •Some specialist services will continue Centre supports the health and care knowledge of local health needs to to be commissioned by NHS England system by collecting, analyzing and plan and buy services for their local centrally where this is most efficient. publishing national data and statistical community from any service provider In collaborating with nationally information. that meets NHS standards and costs. renowned organizations who offer •NHS Blood and Transplant manages These will range from existing NHS health care specialties, NHS England the safe supply of blood to the NHS as hospitals, social enterprises, and is coalescing their expertise to ensure well as organ donation and transplants voluntary organizations through to national standards are consistently in across the UK. private sector providers. CCG’s will place across the country. •The NHS Litigation Authority resolves ensure improved care for patients •Public Health England is strategically fairly all claims made against its by incorporating knowledge of local positioned to provide national scheme members, helping the NHS services to commission services in leadership and expert services to to become a fully functioning learning response to their needs. Additionally: support public health. This organization organization. will work with local government, the •The NHS Business Services Authority •Health and wellbeing boards have NHS and other key partners to respond carries out a range of support services been developed in every area to to health protection emergencies such to the NHS, patients and the public ensure that these services work as the measles epidemic which started together to respond to communities’ in Wales, but is now spreading to Protecting the interests of people using needs and priorities.