The Health and Social Care Bill

• Abstract
• Characteristics of this policy
• Purpose and process analysis
• Expected outcome
• References

Featured in half-yearly report: G-politik in Industrieländern 11

Abstract

The Health and Social Care Bill, announced on 11th July 2007, contains a number of policy initiatives, broadly aimed at a better integration of health and social care regulation, and measures to improve public health. The Bill is still passing through the Houses of Parliament, and has not yet become law. This report summarises the measures proposed in the Bill.

Neue Entwicklungen

There are four principal policy proposals in the Bill:

(1) The creation of a Care Quality Commission (CQC), a new integrated regulator for health and adult social care, which will be formed from the merger of the existing Commission for Social Care Inspection, the Healthcare Commission and the Mental Health Act Commission. The functions of the CQC are to regulate for safety, quality assurance and performance assessment, and to safeguard the rights of mental health patients. It is hoped that the CQC will provide for a more integrated approach, and at a lower total cost, than existing regulators. 

(2) To strenghen clinical governance in the wake of the Shipman Inquiry (Shipman was a GP who murdered a number of his elderly patients). Including within this proposal is the intention to create an independent adjudicator to undertake objective adjudication for the regulatory bodies. Ultimately, the idea is to ensure that the professions are more accountable to the public.

(3) Measures will be introduced to enhance public health protection to help prevent the spread of infectious diseases and limit the risk of contamination. The measures are intended to safeguard human rights by legislating for a proportionate response to the outbreak of infectious diseases that is implemented only when necessary. 

(4) The creation of health in pregnancy grants, which will involve issuing a one-off payment of £190 to women from the 25th week of their pregnancy, to encourage them to adopt a healthy lifestyle in the later stages of their pregnancy. Receipt of the grant is provisional on the woman seeking lifestyle advice from a health professional. 

The first three of the above four policies have been subjected to an impact analysis by the Government, and Ministers have concluded that the benefits exceed the costs. The fourth policy has not been subjected to an impact analysis, because the expected total costs of the policy - £175 million in the first year, falling to £145 million in subsequent years - is apparently not large enough to necessitate such an analysis.

As part of the Bill, the Government is also attempting to introduce a number of minor policies, including the abolition of the Liable Relatives Rule, which will mean that the spouse of a person in a care home will no longer have to contribute towards the costs of his/her care.

   

Innovationsgrad	traditionell		innovativ
Kontroversität	unumstritten		kontrovers
Strukturelle Wirkung	marginal		fundamental
Medienpräsenz	sehr gering		sehr hoch
Übertragbarkeit	sehr systemabhängig		systemneutral
current    previous

I am not aware of how controversial the contents of the final Bill are - presumably, the consultation exercises were able to iron out the main concerns of the principal stakeholders before the Bill was sent to parliament. I will hopefully be able to say more about the impact of the Bill in a couple of years time, but as of now, as mentioned above, the Bill does look on the whole reasonably sensible.

Purpose and process analysis

Current Process Stages

	Idee	Pilotprojekt	Strategiepapier	Gesetzgebung	Umsetzung	Evaluation	Veränderung/Richtungswechsel
Implemented in this survey?

Initiators of idea/main actors

• Regierung

• Parlament: The Bill is currently passing through the House of Lords - we'll wait to see whether or not they are supportive

Stakeholder positions

The Government undertook an extensive consultation process before they sent the Bill to Parliament. The various parts of the Bill were sent for consultation at different times between 2006 and 2007, and those consulted included NHS bodies, charities, health and social care regulators, the General Medical Council, the British Medical Association and the Royal Colleges, patient organisations, consumer groups, the Health Protection Agency, and Liberty (a human rights group). The Bill has passed through the House of Commons, and is currently being considered by the House of Lords (the two Houses of Parliament).

Actors and positions

Regierung
Central Government	sehr unterstützend		stark dagegen
Parlament
At the moment, the House of Lords	sehr unterstützend		stark dagegen
current    previous

Influences in policy making and legislation

The Bill, as described above, is currently being considered by the House of Lords, as mentioned above. I'm not aware that anything in the Bill has been changed yet, but it is possible that the House of Lords may demand this and then send the Bill back to the House of Commons (it is also possible that they won't demand any changes). Thus, the outcome of the Bill is not yet known, but I would be very surprised if it is not passed into law.

Legislative outcome

n/a

Actors and influence

Regierung
Central Government	sehr groß		kein
Parlament
At the moment, the House of Lords	sehr groß		kein
current    previous

Positions and Influences at a glance

Adoption and implementation

The actors involved at the moment are the Houses of Parliament (Commons and Lords). As noted above, a great many stakeholders were consulted about the content of the Bill before the Government submitted it to Parliament.

Monitoring and evaluation

Too early to tell. The Bill has not become law yet. But the Government will of course be responsible for implementing the changes and policies contained in the Bill if it is passed by parliament. The main proposed change, of course, is more 'structural' than 'outcome' based - i.e. the merging of some of the existing regulatory agencies to try to reduce administrative costs and to try to produce greater consistency across health and social care policy.   

Expected outcome

The social care experts that I have spoken to feel that the content of the Bill is sensible in principle, but are a little concerned that social care issues may become subsumed by health policy concerns. Regarding the health in pregnancy grants, it could be questioned why these were not targetted towards the materially deprived rather than being available for everyone (in which case the grants could have been increased beyond £190 to those who are arguable in most in need of them), and it is also questionable as to whether the £190 will be spent on health promoting activities. Nonetheless, the requirement that women seek health promotion advice as a condition of receiving the grant is sensible, and, overall, the contents of the Bill generally appear reasonable to me.

Impact of this policy

Qualität	kaum Einfluss		starker Einfluss
Gerechtigkeit	System weniger gerecht		System gerechter
Kosteneffizienz	sehr gering		sehr hoch
current    previous

The policies have not been implemented yet - therefore, I cannot of course sensibly comment on their impact.

References

Sources of Information

Department of Health. 2008. Health and Social Care Bill. Department of Health: London.

Department of Health. 2008. Overarching cover note of the impact assessments for the Health and Social Care Bill. Department of Health: London.

Department of Health. 2008. Health in pregnancy grant. Department of Health: London.

Department of Health. 2007. Public health protection measures. Department of Health: London.

Department of Health. 2007. Professional regulation. Department of Health: London.

Department of Health. 2007. Care quality commission. Department of Health: London.

 

Reform formerly reported in

Developments in social care Process Stages: Idee

Integrating community health and social care Process Stages: Strategiepapier, Idee

Author/s and/or contributors to this survey

Adam Oliver

Empfohlene Zitierweise für diesen Online-Artikel:

Adam Oliver. "The Health and Social Care Bill". Health Policy Monitor, April 2008. Available at http://www.hpm.org/survey/gb/a11/1