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Restructuring of the NHS - Health and Social Care Act 2012

View profile for Judith Thomas-Whittingham
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In 2010 it was recognised by the Government that the NHS needed modernising to meet the new challenges of today and to avoid the crises of tomorrow.

In 2012 the Health and Social Care Act received its Royal Assent and has been implemented in stages to reform the way in which health and social care services in England are funded, commissioned and administered.

However, the most radical change will come into force on 1st April 2013 when the NHS will have new structure for the provision of services. It will be the most extensive re-organisation of the NHS to date.

New Structure

The Secretary of State will see their role and responsibilities change under the Act. They will remain responsible for the NHS but will no longer have a duty to provide health services through the NHS, increasing the opportunity for private health care firms to deliver many services that were previously operated by the NHS.

In addition, the Act will abolish Strategic Health Authorities and replace them with a new National Commissioning Board (NCB), set up to provide leadership for local Clinical Commissioning Groups (CCGs) as well as commissioning some specialist and primary care services such as GPs, dentists, community pharmacies and opticians.

CCGs will abolish Primary Care Trusts which currently control around 80% of the NHS Budget and will be a GP led body with responsibility for most health services, including GPs, dentists and pharmacies as well as some secondary care services provided by hospitals. 

Furthermore, a new body called ‘Public Health England’ will also be created to provide leadership to local authorities and work with other bodies to promote public health issues


The Act introduces some new bodies to regulate and monitor the health and social care services in England whilst extending the powers for others. In addition to the above responsibilities, the NCB will have a duty to protect and promote patients’ interests as well as tackle abuses and unjustifiable restrictions of competition.

The National Institute for Health and Clinical Excellence (NICE) will have its powers expanded to include the development of quality standards for social care. It will also assist in providing much needed guidance to GPs, CCGs as well as community and secondary care services.

The Care Quality Commission (CQC) will also assist in regulating the providers of health and adult social care services, such as the NHS, in addition to making sure its standards of quality and safety are met.

A new independent national body called ‘Healthwatch’ will be set up to protect the interests of all those who use health and social care services. It will also have the important role of communicating the views of patients and providing information, advice and support to them.

Health and social care commissioners, councillors and lay representatives will be brought together into ‘Health and Wellbeing Boards.’ The Boards’ responsibilities will include assisting in promotion of joint working and tackling the inequalities in people’s health and wellbeing in their local area.

The Act confirms that the NCBs, the CQC and NICE will all be directly accountable to the Department of Health, which in turn will still be accountable to Parliament.


The complaints process will remain the same under the Act with the Patient Advice and Liaison Service (PALS) and the Independent Complaints Advocacy Service (ICAS) continuing to assist with the process. However, the new independent body ‘Healthwatch’ will also be available to provide advice and guidance to patients who have a grievance about the treatment they have received.

Overall, the Health and Social Care Act 2012 aims to empower patients, giving them a greater voice and control of their own care. It will put clinicians at the centre of commissioning, free up providers to innovate and give new focus on public health. The NHS is in much need of reform and hopefully the new roles and responsibilities set out in the Act will ensure the NHS is more accountable both locally and nationally.

By Sarah Fairclough