NHS changes not April fools joke

One in Four editor Mark Brown summarises the NHS changes coming up on April 1st that may have passed you by

April the 1st is the date of one of the largest reorganisations of the National Health Service in England since its birth in 1948. Most of the changes are concerned with who makes decisions about health and social care and who services are provided by. These changes will not have a huge immediate impact on day-to-day services but are significant long-term changes to how the NHS works

Clinical Commissioning Groups (CCGs) formally replace Primary Care Trusts (PCTs) as the bodies which commission care. They have the power to buy services from any provider that meets agree standards, not just from within the NHS. Clinical Commissioning Groups include GP practices and other health professionals. While all GP practices have to be members of a CCG, the level of power individual GPs have will differs from area to area. While CCGs may have been initially envisaged as smaller and more local than PCTs, the 211 CCGs cover areas of similar size and population to the now defunct PCTs.

Local Authorities (councils) now have responsibility for public health, meaning they will control budgets for taking actions to improve the health of the whole community they serve . The government expects them to work more closely with other health and care providers, community groups and agencies, using knowledge of local communities to tackle challenges such as smoking,alcohol and drug misuse and obesity.

Sitting between CCGs and Local Authorities are Health and Wellbeing Boards, made up of health and social care decision makers and elected members of the public. A kind of steering group, Health and Wellbeing Boards feed into decision-making such as the Joint Strategic Needs Assessment process that works out what an area must to do to address the needs of those who live there. They are also expected to lead on reducing health inequalities (differences in health between different groups or areas). The Health and Wellbeing Board will, in theory, be where the views of members of the public will influence decisions.

Also on April 1st the process of switching patient and public engagement organisations from Local Involvement Networks (LINks) to Local Health Watch will be completed. LINks, first created by the Labour government in 2008, were independent bodies hosted by voluntary organisation intended to hold health and social care service to account and to feed in local views to decision makers. Each local HealthWatch has a similar remit. In some areas the organisation that had run LINks were successful in bidding to become a local HealthWatch while in others Local Healthwatch will be run by a new organisation.

While maintaining its leadership role, The Department of Health will from April 1st no longer directly manage NHS organisations. Some of this function have been passed to the NHS Commissioning Board, which will oversee CCGs and will agree their funding. This, in theory, shifts decision making outside of government for the NHS, although the Secretary of State for Health, currently Jeremy Hunt, retains the ultimate responsibility for the overall system. The organisation, Monitor, has the role of regulating all of the new structures of the NHS. They will also from 2014 be the body that approves and provided licenses to bodies both NHS and none-NHS that provide services to NHS patients. Along with the NHS Commisisoning Board, Monitor will also be responsible for setting the pricing of NHS services to work out the cost of patient care from 2014/15.

The reorganisation is the result of the changes to the ways in which health and social care is to be delivered brought into effect by The Health and Social Care Act 2012. The Act had a long passage into law under the leadership of the previous Health Secretary Andrew Lansley, and the changes that it has created still divide opinion. While Social Care is included in name in these reforms; a Care and Support Bill which will clarify future structures is currently at draft stage.

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