UK/2012 Health and Social Care Act

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Event.png UK/2012 Health and Social Care Act (law) Rdf-entity.pngRdf-icon.png
DescriptionThe most extensive reorganisation of the structure of the National Health Service in England to date.

The 2012 Health and Social Care Act is an Act of the Parliament of the United Kingdom which provides for the most extensive reorganisation of the structure of the National Health Service in England to date.[1] It removed responsibility for the health of citizens from the Secretary of State for Health, which the post had carried since the inception of the NHS in 1948. It abolished NHS Primary Care Trusts (PCTs) and NHS Strategic Health Authorities (SHAs) and transferred between £60 billion and £80 billion of "commissioning", or health care funds, from the abolished PCTs to several hundred "Clinical Commissioning Groups", partly run by the General Practitioners (GPs) in England but a major point of access for private service providers. A new executive agency of the Department of Health, Public Health England, was established under the Act on 1 April 2013.[2]

The proposals are primarily the result of policies of the then Secretary of State for Health, Andrew Lansley. Writing in the British Medical Journal, Clive Peedell (co-chairman of the NHS Consultants Association and a consultant clinical oncologist) compared the policies with academic analyses of privatisation and found "evidence that privatisation is an inevitable consequence of many of the policies contained in the Health and Social Care Bill".[3] Lansley said that claims that the government is attempting to privatise the NHS are "ludicrous scaremongering".[4]

The proposals contained in the Act are some of the coalition government's most controversial. Although glanced at in the Conservative Party's manifesto in 2010,[5] they were not discussed during the 2010 General Election campaign and were not contained in the ConservativeLiberal Democrat coalition agreement, which mentioned the NHS only to commit the coalition to a real-term funding increase every year.[6] Within two months of the election a White Paper was published, outlining what the Daily Telegraph called the "biggest revolution in the NHS since its foundation".[7] The Bill was introduced in the House of Commons on 19 January 2011.[8][9] In April 2011 the government announced a "listening exercise", halting the Bill's legislative progress until after the May 2011 local elections. The "listening exercise" finished by the end of that month. The Bill received Royal Assent on 27 March 2012.

Ten Years On

The Health and Care Act 2022 is an Act of the Parliament of the United Kingdom that was introduced into the House of Commons in July 2021 and is intended to dismantle many of the structures established by the Health and Social Care Act 2012.[10] Many of the proposals were drafted under the leadership of Simon Stevens and are intended to reinforce the ambitions of the NHS Long Term Plan. It is the first substantial health legislation in the premiership of Boris Johnson. It was proposed to take effect in April 2022, but in December 2021 it was reported that implementation would be delayed until July 2022.


The Health and Care Act 2022 puts integrated care systems on a statutory footing, and merges NHS England and NHS Improvement.

It provides for the Care Quality Commission to assess how local authorities deliver their adult social care functions.

It establishes an integrated care board and an integrated care partnership in every part of England. Each board is required to have, as a minimum:

  • Four executives: the chief executive and finance, nursing and medical directors.
  • Three independent non-executives: a chair and at least two others. They "will normally not hold positions or offices in other health and care organisations within the ICS footprint".
  • Three "partner members": one from an NHS trust/foundation trust in the patch, one from general practice, and one from a local authority.

The Department of Health and Social Care launched a consultation on a proposed new 'provider selection regime' in 2022. This took effect with the passing of the Act and effectively ends the NHS internal market as NHS commissioners will no longer be automatically obliged to put clinical services out to tender.

It allows NHS Digital to collect more information on medicines to analyse their use and safety and request information from private providers and makes it a criminal offence to share that data inappropriately.

It puts a £86,000 cap on the amount anyone in England will have to spend on their personal care over their lifetime.

It is claimed that it will "dispose of unnecessary bureaucracy that has held the health service back", and will ensure the NHS is "more accountable to government".

It includes provisions which would give the Secretary of State for Health and Social Care more power to direct NHS agencies, including NHS England and Improvement, and over "notifiable" service changes, which will be defined in regulations. If ministers "call in" a reconfiguration proposal for review, they must make a final decision within six months.

The Act criminalises "aiding and abetting" women to undergo hymenorrhaphy, or hymen reconstruction surgery, along with virginity testing.

The government agreed three amendments in discussions in the House of Lords relating to mental health in February 2022: requiring the definition of 'health' to include mental health; to place a duty on new integrated care boards to have mental health expertise; and to require more transparency and accountability on mental health funding.

The Health and Care Act 2022 also includes a target of the NHS achieving net zero carbon emissions by 2040.[11]


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