Description
The Department of Health and Social Care (DHSC) is the UK government department responsible for government policy on health and adult social care matters in England, along with a few elements of the same matters which are not otherwise devolved to the Scottish Government, Welsh Government or Northern Ireland Executive. It oversees the English National Health Service (NHS). The department is led by the Secretary of State for Health and Social Care with three Ministers of State and three Parliamentary Under-Secretaries of State.
The department develops policies and guidelines to improve the quality of care and to meet patient expectations. It carries out some of its work through arms-length bodies (ALBs), including executive non-departmental public bodies such as NHS England and the NHS Digital, and executive agencies such as Public Health England, the UK Health Security Agency and the Medicines and Healthcare products Regulatory Agency (MHRA).
History
The Department of Health was formally created in 1988 through The Transfer of Functions (Health and Social Security) Order. Like many others, the department with responsibility for the nation's health has had different names and included other functions over time.
In the 19th century, several bodies were formed for specific consultative duties and dissolved when they were no longer required. There were two incarnations of the Board of Health (in 1805 and 1831) and a General Board of Health (1854 to 1858) that reported directly into the Privy Council. Responsibility for health issues was also at times, and in part, vested in local health boards and, with the emergence of modern local government, with the Local Government Act Office, part of the Home Office. In the early part of the 20th century, medical assistance was provided through National Health Insurance Commissions.
The first body, which could be called a department of government was the Ministry of Health, created through the Ministry of Health Act 1919, consolidating under a single authority the medical and public health functions of central government. The co-ordination of local medical services was expanded in connection with emergency and wartime services, from 1935 to 1945, and these developments culminated in the establishment of the NHS in 1948.
In 1968, the Ministry of Health was dissolved and its functions transferred (along with those of the similarly dissolved Ministry of Social Security) to the newly created Department of Health and Social Security (DHSS). Twenty years later, these functions were split back into two government departments, forming the Department of Social Security (DSS) and the Department of Health.
After the 2018 British cabinet reshuffle, the department was renamed the Department of Health and Social Care.
Location
The department's headquarters and ministerial offices are at 39 Victoria Street, London. The department moved from its previous location in Richmond House, Whitehall in November 2017. Its other principal offices are Skipton House (Elephant and Castle), Wellington House near Waterloo station and Quarry House in Leeds. Wellington House is now mainly occupied by staff from the department's arms-length bodies. New King's Beam House near Blackfriars Bridge was formerly a Department of Health office prior to the expiry of its lease in October 2011. Alexander Fleming House, Hannibal House and Eileen House (all in Elephant and Castle) were previously used by the department. The archives are at Nelson, Lancashire.
Arms-length bodies (ALBs)
The department acts as a 'steward' for the health and adult social care system in England and oversees fifteen arms-length bodies (ALBs):
Executive agencies
The department has two executive agencies:
- The Medicines and Healthcare products Regulatory Agency has the specialist role of assessing, licensing and regulating medicines and medical devices for use in the United Kingdom.
- Until April 1, 2021, Public Health England was responsible for delivering public health improvement through prevention and awareness raising and protection. This will be moved to a new "Office for Health Promotion", announced on March 29, 2021. There has been little information on how the Office would be funded.
Executive non-departmental public bodies
The department has thirteen executive non-departmental public bodies:
United Kingdom
The Human Tissue Authority regulates the use of human tissue in research and therapeutic treatments across the United Kingdom.
The Human Fertilisation and Embryology Authority, which regulates and inspects in vitro fertilisation, artificial insemination and the storage of human eggs, sperm or embryos. It also regulates human embryo research.
England and Wales
- NHS Blood and Transplant, which is responsible for the supply of blood, organs, tissues and stem cells; their donation, storage and transportation.
- The National Institute for Health and Care Excellence, 'NICE', which provides advice on treatment procedures and assesses healthcare interventions for cost-effectiveness.
- The NHS Business Services Authority provides business support services to NHS organisations, including the administration of the NHS pension scheme.
England only
- The Care Quality Commission has the primary function of inspecting providers of health and adult social care in England, ensuring that they meet essential standards of safety and quality.
- NHS Digital, which provides statistical information and informatics support to the health and care system in England.
- Health Education England is responsible for ensuring enough high-quality training is available to develop the healthcare workforce.
- NHS England oversees the NHS in England, commissions specialised healthcare services and primary care services and oversees clinical commissioning groups.
- NHS Improvement which, from 1 April 2016, combines the roles of the:Monitor, which oversaw foundation trusts and applications from NHS trusts seeking foundation trust status. It also had the new role of examining pricing and competition in the NHS.
- The NHS Trust Development Authority had the function of helping NHS trusts achieve successful applications for foundation trust status.
- The Health Research Authority protects and promotes the interests of patients and the public in health research.
- NHS Resolution, handles negligence claims and helps the NHS learn lessons from claims to improve patient and staff safety.
- The NHS Counter Fraud Authority, tasked with leading the fight against NHS Fraud and corruption.
Criticism
Introduction of user charges for NHS services
The publication of Professor Lord Darzi's review of the NHS prompted criticism of the government and the Department of Health, claiming that it paved the way for user charging, and so contradicting the NHS Plan 2000 which stated that "user charges are unfair and inequitable in they increase the proportion of funding from the unhealthy, old and poor compared with the healthy, young and wealthy". The report also introduces the concept of personal budgets.
Fragmentation of NHS services
Darzi's report splits previously integrated services into 'core', 'additional' and 'enhanced' services, which critics say will lead to abandoning the open-ended duty of care on which the NHS was founded.
"Superbugs" and PF
Fatal outbreaks of antibiotic-resistant bacteria ("superbugs"), such as Methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile, in NHS hospitals has led to criticism in 2008 of the department's decision to outsource cleaning via private finance initiative contracts as "cutting corners on cleaning".
A "Deep Clean" initiative announced by the Department of Health was criticised by infection control experts and by the Lancet as a gimmick which failed to address the causes of in-hospital infections, by the firms doing the work as an attempt to avoid paying for regular better cleaning, and by NHS managers as ineffective.
It also attracted criticism because only a quarter of the £60m funding for the scheme went to hospitals, and because a number of hospitals missed the completion target, and as of June 2008 one in four NHS trusts was not meeting the government's standards on hygiene.
Prescribing
Its advice to primary care on prescribing drugs such as proton pump inhibitors has been criticised as wasteful.
Medical training
The DH has attracted criticism for its handling of the outcome of Modernising Medical Careers, in particular in the changes it made to the specialist training of doctors and the Medical Training Application Service (MTAS). These changes left "29,193 junior doctors from the UK and overseas... chasing 15,600 posts..." and resulted in accusations that the DH had broken the law by refusing to reveal scores to candidates. Ultimately there was a judicial review and a boycott of the system by senior doctors across the country. MTAS was eventually scrapped and Patricia Hewitt, the then Secretary of State for Health, resigned[clarification needed] following accusations that she had lied to the House of Commons over the system. Even after the abolition of MTAS, anger among the medical profession continued, with the British Medical Association commenting of the DH response that "Not only is this response too late, it does not go far enough".
The official government inquiry into MMC recommended that the responsibility for medical training be removed from the DH.
Recurrent NHS reorganisation
Successive DH ministerial teams have been criticised for repeated reorganisations of the NHS in England, where primary care commissioning responsibility, in particular, has been allocated to four different sets of organisations in the last ten years: PCGs,[clarification needed] small area Primary Care Trusts (PCTs) (e.g. covering a rural local authority district or part of a city), larger-area PCTs (e.g. covering a whole county), PCT clusters (e.g. quarter of London or South of Tyne and Wear) and the currently unspecified Clinical Commissioning Groups. The tendency to introduce each reorganisation before its predecessor has had time to settle down and generate improved performance has attracted censure amongst healthcare professions in the UK and beyond, including reference to the ironic concept of 'redisorganization'.
Andrew Lansley's promise before the 2010 general election not to impose top-down reorganisation, followed by the instigation from ministerial level of one of the most fundamental NHS reorganisations yet envisaged, has generated especially widespread opprobrium, although some commentators have also suggested that this is to some extent completing the job started under the Blair administration.
The NHS as of 1 April 2013 is no longer situated within the DH, as NHS England also went 'live' at the same time. Therefore, the DH has a further scrutiny role of NHS services and commissioning. (See Arms Length Bodies section).
Information technology
In recent years the Department of Health and the NHS have come under considerable scrutiny for its use of IT. Since being elected to power in 1997 the Labour government had sought to modernise the NHS through the introduction of IT. Although the policy is correct in aim, many claim its execution is lacking.
In September 2008 a new leadership team was established, CIO for Health, Christine Connelly, and director of programme and system delivery Martin Bellamy. Previous CIO Richard Granger was believed to have been the most highly paid civil servant in the UK and was a controversial figure. Connelly left the DH for a position in the Cabinet Office in June 2009 and was replaced by Tim Donohoe and Carol Clarke.
Connelly's role was to "deliver the Department's overall information strategy and integrating leadership across the NHS", according to the DH's website. That strategy, known as the National Programme for IT, is intended to do nothing less than revolutionise NHS information workflow and is costed at about £12.7bn. The success or otherwise of Connelly's reign will be based on her promise to end delays of electronic medical records. She has said that if there is not clear progress by November 2009, a new plan could be hatched.
On the eve of the departure of Fujitsu as an outsourcing partner, Connelly said in April 2009 that she would open up sourcing to competition at "acute" sites in the south of England and offer toolkits by March 2010 to allow more local configuration of systems.
In January 2009, MPs criticised DH for its confidentiality agreement with key supplier CSC and in March the department was admonished by the Information Commissioner for its records management. In May 2011, Prime Minister David Cameron announced that he was considering scrapping the project.
2010–11 staffing cuts
In response to Government spending reduction targets following the 2008-9 international financial crisis and subsequent recession, DH in common with several other Government Departments resorted to large-scale staffing reductions. In order to minimise redundancy costs,[citation needed] the predominant impact was upon DH staff not employed through a traditional civil service 'headcount' contract, with a resultant emphasised effect upon more recent or innovative work-streams dependent upon seconded or externally hosted staff. This has attracted criticism from several of the professional and patient communities of interest concerned, for instance as regards the impact upon Improving Access to Psychological Therapies (IAPT) and the withdrawal of the practical assistance available to the NHS and local authorities via the national support teams.
Devolution
Most health policy in Scotland, Wales and Northern Ireland is devolved to the department's counterparts:
- the Scottish Government Health and Wellbeing Directorate
- the Welsh Government
- the Department of Health, Northern Ireland Executive
A number of health issues are, however, wholly or partly reserved to Westminster:
Scotland
- regulation of the health professions
- abortion
- xenotransplantation
- embryology, surrogacy and human genetics
- human fertilisation
- medicines, medical supplies and poisons
Northern Ireland
- xenotransplantation
- surrogacy
- human fertilisation and embryology
- human genetics
In Northern Ireland, abortion law is a criminal justice matter and is devolved.
Wales
Under the Welsh devolution settlement, specific policy areas are transferred to the Welsh Government rather than reserved to Westminster. As the distinction between government and actual health services is seen as less pronounced than in England, the main source of information about current developments is the NHS Wales article.
