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The Health and Social Care Act

The tale in a timeline

The King's Fund

on 23 April 2013

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Transcript of The Health and Social Care Act

1948 National Health Service launched. 'The greatest gift a nation ever gave itself'. 1974 First significant NHS reorganisation in 25 years. Regional, area and district health authorities replace regional hospital boards, taking over public health, ambulances and other services from local authorities. 1981 1989 creates NHS internal market with 'self-governing' NHS hospitals (NHS trusts) and GP fundholding. Takes effect 1991. 1997 Labour wins power. Pledged to 'abolish' NHS market. Does abolish fundholding, keeps purchaser-provider split. 2004 First foundation trust created. Practice-based commissioning announced. Pilots of 'choice' of hospital for routine treatment launched. By 2008, patients able to choose any hospital, public or private, prepared to treat at NHS prices. 2005 Andrew Lansley sets out his basic ideas for NHS reform. Delegation of budgets to GPs, need for independent providers to have 'right to supply' NHS with a new 'pro-competitive' economic regulator, drawing on lessons from utility privitisation. July 2006 David Cameron starts 'detoxification' of NHS as an issue for the Conservatives. Rules out alternatives to tax-funded NHS. It should remain 'free at the point of need, available to everyone'. January 2006 October Cameron says his priorities for government can be spelt out in three letters '....N.H.S'. With Lansley, launches preview of Autonomy and Accountability White Paper which contains core of 2012 White Paper . Promises 'to end the damage caused by pointless and disruptive reorganisations of the NHS.' 2007 NHS Autonomy and Accountability White Paper published. Followed in 2008 and 2009 by assorted other policy papers, some setting out more detail. 2009 Cameron repeatedly promises no more 'pointless', 'tiresome' reorganisations. Detail of Lansley plans becomes less precise in public. 2010 January Cameron launches billboards promising to 'cut the deficit, not the NHS'. Lansley told to stop discussing detail of NHS reform ahead of election. First of what will be more than a dozen reorganisations of various forms of health authority in the next 30 years. 2010 May 6 Cameron's 'big, open and comprehensive'
offer to the Liberal Democrats to form a coalition government. May 9, coalition agreement reached. 2010 July 12 Nick Clegg describes the paper as 'a bold vision' resulting from 'a blend of Conservative and Liberal Democrat ideas'. NHS White Paper - - published. 2010 October 7 Consultation on the White Paper closes. The King's Fund summarises many concerns by saying the reforms go 'too far and too fast'. http://www.kingsfund.org.uk/press/press_releases/too_far_too_fast.html http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_117353 2010 December 15 Government response to the consultation on the White Paper says it will go ahead with few changes. David Nicholson appointed chief executive designate of NHS Commissioning Board. 2011 January 18 2011 David Bennett, chairman of Monitor, says the changes are like utility regulation. 'There is actually 20 years' experience of taking monopolistic, monolithic markets and providers and exposing them to economic regulation.' February 25 2011 March 12 Liberal Democrat spring conference calls for big changes to the Bill. http://www.libdems.org.uk/latest_news_detail.aspx?title=Motion_carried_with_amendments%3a_Updating_the_NHS%3a_Personal_and_Local&pPK=dabf4d29-021d-4366-8891-b38f40d44bc8 2011 Special conference of the calls for Bill to be withdrawn. March 15 2011 April 4 Andrew Lansley reluctantly and formally announces a 'pause' in the legislation and the creation of the Future Forum. PM's spokesman says government will not only pause but 'listen, engage and amend'. 2011 June 13 https://www.gov.uk/government/publications/nhs-future-forum-recommendations-to-government-on-nhs-modernisation Future Forum reports, with all but one recommendation accepted next day by the coalition. Tory backbenchers 'sulphurous' over Nick Clegg's claims of 'victory' over changes. Lansley tells them his 'red lines' have not been crossed. 2011 annual conference calls again for the Bill to be withdrawn, despite Future Forum changes. June 28 2011 September 7 Bill clears the Commons after 1,000 amendments, many technical, tabled. 2012 February 10 Conservative Home, influential Tory website, says Bill could prove to be the government's 'poll tax' and that it 'must be stopped before it's too late'. http://conservativehome.blogs.com/thetorydiary/2012/02/the-unnecessary-and-unpopular-nhs-bill-could-cost-the-conservative-party-the-next-election-cameron-m.html 2012 February 20 Cameron holds Number 10 meeting with those 'constructively engaged' with the reforms - producing angry protests from BMA, RCN, RCGP and others excluded and leading to more royal college votes, usually on low turnouts, for the Bill to be withdrawn. 2012 March 19 Bill clears House of Lords after the government accepts string of late amendments. 2012 Royal Assent after final Commons debate on March 20. March 27 http://www.legislation.gov.uk/ukpga/2012/7/contents/enacted Andrew Lansley, the Health Secretary, said:

‘The Health and Social Care Act will deliver more power to clinicians, it will put patients at the heart of the NHS, and it will reduce the costs of bureaucracy. We now have an opportunity to secure clinical leadership to deliver improving quality and outcomes; better results for patients is our objective.' The Health and Social Care Act The tale in a timeline http://www.conservatives.com/pdf/NHSautonomyandaccountability.pdf Commons health select committee says the reforms have 'blunted' the ability to make £20 billion of efficiency savings. The risks 'of an already high-risk strategy' have risen. Its chair, Stephen Dorrell, had earlier stated that the need to make up to £20 billion in efficiency savings should take precedence over reforms. Shirley Williams says: 'We cannot be bound by those issues that have never been agreed by us....This is not the moment to embark upon a reorganisation of the most trusted public service in the whole of the United Kingdom'. Clegg she says will have to tell Cabinet colleagues 'I can't get this through my party'. 2012 Nick Clegg and Shirley Williams set out 'final amendments', which, once agreed, mean the Bill 'should be allowed to proceed'. February 27 2000 Alan Milburn launches NHS Plan - focus is on improving access to hospital and primary care, with targets to drive down waiting times. 2010 Coalition's 'programme for government' published. Crucially promises 'no more top down reorganisations' of NHS. May 19 http://www.conservatives.com/pdf/NHSautonomyandaccountability.pdf 2012 September Jeremy Hunt replaces Andrew Lansley as Secretary of State for Health in a ministerial reshuffle. 2012 October The NHS Commissioning Board is formally launched. The Board will have overall responsibility for the £95 billion NHS commissioning budget from 1 April 2013. 2012 November The first NHS Commissioning Board Mandate is published - a heavily amended and slimmed-down version of the original draft. http://www.kingsfund.org.uk/mandate 2013 February A political row breaks out over regulations governing procurement under Section 75 of the Act, re-igniting tensions about the extent of competition in the NHS. http://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/regulating-the-nhs-market-in-england-bmj-chris-ham-mar13.pdf 2013 April 1 The main elements of the Health and Social Care Act come into force. The NHS Commissioning Board (re-named 'NHS England'), clinical commissioning groups, health and wellbeing boards and Public Health England take up their new statutory responsibilities. Find out more about the new NHS at: http://www.kingsfund.org.uk/new-nhs
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