The new NHS: a reform you could see from space?
[A guest post by Jennie Grimshaw, Lead Curator for social policy and official publications at the British Library.]
The controversial Health and Social Care Act 2012 ushered in the most radical reform of the National Health Service since its launch in 1948. On April 1st 2013, the main changes set out in the Act came into force, and most parts of the NHS will be affected in some way.
Clinical commissioning groups (CCGs) replace primary care trusts (PCTs) and are the cornerstone of the new system. There are 211 CCGs in total, commissioning care for an average of 226,000 people each. Each of the 8,000 GP practices in England is now part of a CCG. These groups will commission the majority of health services, and in 2013/14 will be responsible for a budget of £65bn, about 60% of the total NHS budget. CCGs will be accountable to and supported by NHS England, formerly the NHS Commissioning Board, which will also directly commission primary care and specialist services. NHS services will be opened up to competition from providers that meet NHS standards on price, quality and safety, with a new regulator (Monitor) and an expectation that the vast majority of hospitals will become foundation trusts by 2014.
In addition, local authorities will take on a bigger role, assuming responsibility for budgets for public health. Health and wellbeing boards will have duties to encourage integrated working between commissioners of services across health, social care and children’s services, involving democratically elected representatives of local people. Local authorities are expected to work more closely with other health and care providers, community groups and agencies, using their knowledge of local communities to tackle challenges such as smoking, alcohol, drug misuse and obesity
Finally, the Local Involvement Networks (LINks) were replaced by 152 Local Healthwatch operating under the leadership of a new consumer champion, Healthwatch England. Each local Healthwatch is part of its local community, and will work in partnership with other local organisations to ensure that the voices of consumers and those who use services reach the ears of decision makers.
The Coalition government’s radical reform of the NHS has attracted criticism on various grounds: of cost and disruption; backdoor privatisation; introduction of price competition, which risks decisions being made on the basis of price rather than clinical need; and determined opposition from health professions.
The scope of the collection
In the light of this debate, the British Library has chosen the NHS Reform of 2013 for its first themed collection of archived websites under the new Non-Print Legal Deposit Regulations which allow it to gather and preserve all sites in the UK web domain. For this collection we have hand-selected the sites of:
- NHS bodies abolished under the reform (primary care trusts. LINks, strategic health authorities and some public health programmes and agencies). Many of these archived sites are already publicly available in the UK Web Archive. (See also this earlier post);
- The emerging new bodies (clinical commissioning groups, health and wellbeing boards, and local healthwatch);
- Groups campaigning for or (mainly) against the changes (medical royal colleges, professional associations, medical charities, trade unions, grass roots organisations);
- Press and media commentators (including blogs, the BBC and national newspapers from the Sun to the Guardian);
- The Government and the regulators (including legislation);
- The private sector providers preparing to move into the market.
Behind the scenes, this intensive crawl of a relatively small number of sites is going on alongside the general crawl of the whole UK domain which we blogged about last week. These sites are being crawled more frequently than would be typical for the domain crawl, but for a three month period.
The collection will be available for onsite access at the six legal deposit libraries for the UK from this summer. We hope that it will present a balanced view of the impact of the reform, and the debate surrounding it. We'll be blogging again nearer the time with a review of the archive.