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After 2 years of acrimonious debate and political compromise, the British parliament passed what is arguably the most extensive and controversial piece of health legislation since the creation of the NHS. The 2012 Health and Social Care Act ushers in a complex set of organisational upheavals in England and redefines the relationship between the health service and government.
The reforms are intended to ‘liberate’ day-to-day management of the NHS from direct ministerial control through the creation of an independent NHS Commissioning Board; give doctors greater responsibilities for deciding how the NHS budget is spent; establish a number of significant new roles for local government and create a more competitive market in the provision of health services. Compared with previous attempts to reform the NHS, much of this latest change is legally enshrined in a comprehensive and complex piece of legislation, making it significantly more difficult for subsequent governments to undo the reforms and replace them with plans of their own.
Despite its complexity, the legislation does not define precisely how the NHS will function in future—many of the details will be left to those who implement the reforms and work within the new structures. With so much hinging on implementation, the impact of the reforms on mental health services remains uncertain, as it does for other clinical areas. Nonetheless, it is already possible to identify a number of significant risks and opportunities.
From processes to outcomes
The reforms intend to create a cultural change in which the attention of managers and clinicians is shifted from managing processes (eg, bringing down waiting times) to improving patient outcomes. The new NHS Outcomes Framework, which the government will use to hold the independent NHS Commissioning Board to account, includes a range of outcomes that will be monitored over time, including ‘non-clinical’ outcomes such as quality of life and …
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