Intended for healthcare professionals


Implementation of the Health and Social Care Act

BMJ 2013; 346 doi: (Published 03 April 2013) Cite this as: BMJ 2013;346:f2090
  1. Nigel Edwards, senior fellow, leadership development and health policy
  1. 1Kings Fund, London W1G 0AN, UK
  1. n.edwards{at}

Dogged by financial pressures, role uncertainty, and gaps in leadership

The reforms that come into place after implementation of the Health and Social Care Act on 1 April represent the largest set of changes the NHS in England has seen since its formation. The pre-election promise notwithstanding, there have been two huge top down reorganisations—in the NHS and in public health. A vast amount of time and money has been spent on reorganisation and redundancies. Even if the NHS were in a robust financial position this would be a major concern.

The first striking feature is the number of organisations that are new or that have substantially redefined roles. There are 211 clinical commissioning groups (CCGs), 27 area teams, 23 clinical support units, 12 clinical senates, 13 local education and training boards, and 152 health and wellbeing boards. Few of these exactly match any previous jurisdictions and the talk of restructuring further has already begun. The national Commissioning Board (now renamed NHS England), Trust Development Authority, Public Health England, HealthWatch, Health Education England, and academic health science networks are all new. In addition, local authorities will take responsibility for health and wellbeing boards and public health, …

View Full Text

Log in

Log in through your institution


* For online subscription