Health and Social Care Act: Have things changed for better or worse?

The NHS underwent its biggest overhaul with the introduction of the Health and Social Care Act. Health Reporter Helen Rae takes a look at how things are going one year on

14 month Deborah English seen here attending Baby Clinic circa 1957
14 month Deborah English seen here attending Baby Clinic circa 1957

A year ago the NHS underwent one of its biggest changes since its establishment in 1948.

Aneurin Bevan, who was the then Health Secretary, had the ambitious vision of providing free medical care to everyone at their point of need and it was with this ethos that the National Health Service was born.

That vision has seen the health service become the envy of many countries around the world.

Yet in April last year, the NHS underwent one of the largest upheavals in its history.

Controversial changes to the health service were brought in by the Coalition Government which significantly altered the structure of the NHS.

These changes affected who makes decisions about NHS services, how these services are commissioned, and the way money is spent.

Primary Care Trusts and Strategic Health Authorities were abolished, with Clinical Commissioning Groups (CCGs) tasked with planning and buying health care and health services on behalf of their communities.

Local health authorities now have more responsibilities for public health issues and health and wellbeing boards work between commissioners of health services, social care and public health to ensure that patients are at the heart of decisions in the area they live in.

At the time of the proposed changes, serious concerns were raised by medical professionals as it was feared that the Government was fragmenting services.

Neil Hall/PA Wire Health Secretary Jeremy Hunt
Health Secretary Jeremy Hunt

Today a number of health unions remain sceptical that the changes have been in the best interests of patients as they claim a “postcode lottery” has emerged in services offered to those in need of medical treatment.

Estephanie Dunn, Royal College of Nursing Northern Region Operational Manager said: “The RCN warned at the time that the service would be at risk of fragmentation on the back of the changes introduced by the Government.

“Sadly our warnings are proving prescient. For example, since local authorities were put in charge of spending the public health budget, we are now seeing a postcode lottery whereby patients in adjacent beds on the same ward are being asked for their home address, so that the staff can decide what health support services they can be offered.

“You have the bizarre situation whereby two patients with the same needs in the same hospital can be offered two different services, depending on their home postcode.

“We have examples of this happening already, here in the North East. It’s clearly unacceptable from a clinical perspective, but as nurses, we are bound by the Government’s decisions in this regard. It creates an ethical dilemma for the staff, who want to deliver comprehensive, universal services.”

Critics also believe that the changes to the NHS have led to increasing marketisation of the health service, with the risk of private companies putting profit before patients needs.

Dr George Rae from the Beaumont park medical group in Whitley Bay
Dr George Rae from the Beaumont park medical group in Whitley Bay

Dr George Rae, chairman of the North East British Medical Association, said: “The British Medical Association is very concerned about commercial providers who mainly have profit as their over riding concern and we oppose any further moves towards privatisation of the NHS.

“One of our prime concerns is proper integration and collaboration between general practice, the community and hospital care, but that is almost impossible with the incessant reforming of the NHS.

“Many of us would do away with the market, but if we have gone too far down that road we must ensure there must be a move to make the NHS the preferred provider in any healthcare market.

“The NHS must be comprehensive, cost-effective and accountable, and not replaced by a market system which is selective, expensive and unaccountable. This is the pathway we are unfortunately travelling down at present.” In the North East, region-wide issues which put huge strain on the NHS, both financially and in manpower, include issues like obesity, alcohol-related illnesses and medical problems related to smoking.

Local authorities in the area are now in charge of a range of schemes aimed at dealing with these problems, along with a host of other issues affecting the wellbeing of the local population.

Carole Wood, director of public health at Gateshead Council, said: “Now that the public health team is established in the council, we are taking the opportunity to work with councillors and colleagues to influence more areas of public health, such as licensing, trading standards, sport and physical activity, children and young people and community development services.

“And, as director of public health, I now have a strategic position within the organisation, from which I have an overview of all health and wellbeing activities. This includes working with partners in the NHS, voluntary and private sector, towards improving public health. Gateshead Council took on the leadership of the Gateshead Health and Wellbeing Board at the same time as the transition, coordinating the future development of health and social care services.

“There are now strengthened links between the health and social care providers in our area, and collaborative work on integrating health and social care services is already taking shape with the Better Care Fund.

Chappells Paul A Hospital Accident and Emergency department
A Hospital Accident and Emergency department

“Over future years, the public health team has key priorities: to improve health and reduce health inequalities across Gateshead; to help people live healthier lives and ensure that excellent services are available where people need them; and to make a difference to the population’s health.”

For patients, none of the NHS changes have impacted upon the way they access health services day-to day. The way GP appointments are booked and prescriptions sought have remained very much business as usual while the development of the Clinical Commissioning Groups forums has given patients an input into the type of health care delivered.

At North Tyneside CCG, a patient forum is working with its local CCG to ensure the services being provided are right for local people.

The forum is made up of representatives of 17 of the 29 local GP practices within North Tyneside CCG and uses the personal experiences of patients to enhance the wellbeing of local communities.

The 27 representatives who make up the forum have direct influence on the health care which is purchased by the CCG and feedback their experiences and concerns about the NHS services from the practice group members that they receive.

Eleanor Hayward, lay member for public and patient involvement at North Tyneside CCG, who currently chairs the forum, is immensely proud of the group’s achievements.

Members of the forum devised the recent NHS Keep Calm campaign which encouraged people to care for themselves for common winter ailments such as headaches, colds, sore throats, aches and pains or seek the advice of a pharmacist.

Mrs Hayward said: “The forum is a great example of putting patients at the heart of the NHS. The members are a very cohesive group who give their valuable time to make health services better while people at the CCG understand the value of involving patients and genuinely believe this is the way forward.”


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