Department of Health and Social Care

The Department of Health and Social Care (DHSC) is a department of Her Majesty's Government, 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 two Ministers of State and three Parliamentary Under-Secretaries of State.

Department of Health and Social Care
Department overview
Formed1988
Preceding Department
JurisdictionEngland
Headquarters39 Victoria Street
London
SW1H 0EU[1]
Employees2,160[2]
Annual budget£166 billion; 2019–20 ($221 billion)[3]
Minister responsible
Department executive
Websitewww.gov.uk/government/organisations/department-of-health
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The Department of Health develops policies and guidelines to improve the quality of care and to meet patient expectations.

The department carries out some of its work through arms-length bodies (ALBs),[4] including executive non-departmental public bodies such as NHS England and the NHS Digital, and executive agencies such as Public Health England 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.[5]

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.[6]

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 and Hannibal House were previously used by the department. The archives are at Nelson, Lancashire.

Ministers

The Department of Health and Social Care ministers are as follows:[7][8]

Minister Rank Portfolio
The Rt Hon. Matt Hancock MP Secretary of State Overall responsibility
Edward Argar MP Minister of State for Health operational performance; Long Term Plan Bill; finance, efficiency and commercial; NHS capital, land and estates; transformation; NHS England mandate; devolved administrations – non-EU Exit; secondary legislation; departmental management; EU Exit, global development and trade

Sponsorship of: NHSE, NHSI, NHSBSA.

Nadine Dorries MP Minister of State for Mental Health, Suicide Prevention and Patient Safety [n 1] mental health; suicide prevention and crisis prevention; offender health; vulnerable groups; patient safety; women’s health strategy; maternity care; inquiries; patient experience; cosmetic regulation; data and technology; medicines and devices regulation

Sponsorship of: NHS Resolution, CQC, MHRA, NHSX, NHSD.

Helen Whately MP Minister of State for Social Care adult social care; health/care integration; workforce; dementia, disabilities and long-term conditions; abortion; NHS Continuing Healthcare; NHS security management including cyber security; research and life sciences; blood and transplants, organ donation

Sponsorship of: HRA, NHSBT, HTA, HFE, HEE.

Jo Churchill MP Parliamentary Under-Secretary of State for Prevention, Public Health and Primary Care public health system; health improvement; health inequalities; public health delivery; primary care; gender identity services; major diseases; community health; lead minister for crisis response

Sponsorship of PHE and FSA.

The Rt Hon. The Lord Bethell Parliamentary Under-Secretary of State for Innovation life sciences; medicines; research; anti-microbial resistance; global health security; international diplomacy and relations; data and technology; rare diseases; NHS security management, including cyber security; blood and transplants and organ donation

Sponsorship of: NHS Blood and Transplant; The Human Tissue Authority; The Human Fertilisation and Embryology; Authority; The Medicines and Healthcare products Regulatory Agency; The National Institute for Health and Care Excellence; NHS Digital; Health Research Authority; NHSX; NHS Business Services Authority

  1. Promoted from Parliamentary Under-Secretary of State on 5 May 2020

Permanent Secretary

The Permanent Secretary at the Department of Health and Social Care is Sir Christopher Wormald KCB, who was appointed in 2016.

Previous permanent secretaries:

Following the resignation of Sir Nigel Crisp in March 2006, a separate post of Chief Executive of the National Health Service in England was created, held by Sir David Nicholson. Following the Health and Social Care Act 2012 and the creation of the independent NHS Commissioning Board, known as NHS England, this post has evolved into Chief Executive of the new organisation. As of 1 April 2014, the incumbent is Simon Stevens.

Chief professional officers

The department has six chief professional officers who provide it with expert knowledge and also advise the Ministers, other government departments and the Prime Minister. The Chief Medical Officer and Chief Nursing Officer are also directors of the department's board.

  • Chief Medical Officer for England (CMO) — Professor Chris Whitty, appointed in October 2019.
  • Chief Nursing Officer (CNO) — Ruth May, appointed in 2019, although she is now part of NHS England (NHS Commissioning Board)
  • Director of Nursing — Viv Bennett
  • Chief Scientific Officer (CSO) — Professor Sue Hill OBE, appointed in 2002.
  • Chief Dental Officer for England (CDO) — Barry Cockcroft, appointed in 2006.
  • Chief Health Professions Officer (CHPO) — Karen Middleton, appointed in 2007.
  • Chief Pharmaceutical Officer — Dr Keith William Ridge, appointed in 2006.
  • Chief Social Worker for Adults.
  • Chief Social Worker for Children and Families. Role jointly under Department of Education.

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.
  • Public Health England is responsible for delivering public health improvement, through prevention and awareness raising and protection and infection control.

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
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:
  • 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
Quarry House: a DH building shared with the Department for Work and Pensions at Quarry Hill, Leeds (known locally as 'The Kremlin').

Introduction of user charges for NHS services

The publication of Professor Lord Darzi's review of the NHS[9] prompted criticism of the government and the Department of Health, claiming that it paved the way for user charging,[10] 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".[11] The report also introduces the concept of personal budgets.

Fragmentation of NHS services

Darzi's report[9] 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.[10]

"Superbugs" and PFI

Fatal outbreaks of antibiotic-resistant bacteria ("superbugs"), such as Methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile, in NHS hospitals[12] has led to criticism of the DH's decision to outsource cleaning via private finance initiative contracts as "cutting corners on cleaning".[13]

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,[14] by the firms doing the work as an attempt to avoid paying for regular better cleaning,[15] and by NHS managers as ineffective.[15]

It also attracted criticism because only a quarter of the £60m funding for the scheme actually went to hospitals, and because a number of hospitals missed the completion target,[16] and as of June 2008 one in four NHS trusts was not meeting the government's standards on hygiene.[17]

Prescribing

Its advice to primary care on prescribing drugs such as proton pump inhibitors has been criticised as wasteful.[18]

Medical training

The DH has attracted criticism for its disastrous 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..."[19] and resulted in accusations that the DH had broken the law by refusing to reveal scores to candidates.[20] Ultimately there was a judicial review and a boycott of the system by senior doctors across the country.[21] MTAS was eventually scrapped[22] and Patricia Hewitt, the then Secretary of State for Health, resigned following accusations that she had lied to the House of Commons over the system.[23] 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".[21]

The official government inquiry into MMC recommended that the responsibility for medical training be removed from the DH.[24]

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, small area 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'.[25]

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[26] and the NHS have come under considerable scrutiny for its use of IT.[27] 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.[28]

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.[29] 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 is 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,[30] 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" sights in the south of England and offer toolkits by March 2010 to allow more local configuration of systems.[31]

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.[32]

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, the predominant impact was upon DH staff not employed through a traditional civil service 'headcount' contract, with a resultantly 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)[33] 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:

A number of health issues are, however, wholly or partly reserved to Westminster:

Scotland[34]

Northern Ireland[35]

In Northern Ireland, abortion law is a criminal justice matter and is devolved.[36]

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.

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gollark: Well, everything about English makes no sense.
gollark: Most of my greek typing is just one character in the middle of other stuff, so it would not be very useful to me to learn other layouts and set them up.
gollark: If only people (including me...) actually knew IPA so we could avoid messing with "thee-tah" and other ambiguous ways to say how to pronounce things.
gollark: It's not that hard, I just hold LWIN and type gqx.

See also
  • Government of England
  • United Kingdom budget
  • Healthcare in the United Kingdom
  • Health in the United Kingdom
  • National Data Guardian for Health and Care in England

References
  1. "Department of Health and Social Care". gov.uk. Retrieved 4 December 2019.
  2. "About us". GOV.UK. Retrieved 31 January 2020.
  3. Autumn Budget 2018 (PDF). London: HM Treasury. 29 October 2018. Retrieved 11 August 2017.
  4. "[Withdrawn] Arm's length bodies". GOV.UK. Retrieved 4 December 2017.
  5. "Health Departments". ndad.nationalarchives.gov.uk. The National Archives. Archived from the original on 6 November 2006. Retrieved 7 November 2006.
  6. Mikey Smith (8 January 2018). "Jeremy Hunt has got a new job in Theresa May's Cabinet reshuffle after an hour inside Number 10". Daily Mirror.
  7. "Ministers". GOV.UK. HM Government. Retrieved 1 August 2019.
  8. "Her Majesty's Official Opposition - Departments and Shadow Ministers". www.parliament.uk. UK Parliament. Retrieved 1 November 2017.
  9. Professor Lord Darzi KBE (30 June 2008). "High Quality Health Care For All" (PDF). The Department of Health. Retrieved 3 July 2008.
  10. Allyson Pollock (1 July 2008). "Lord Darzi's report paves the way for Labour to charge for NHS care". London: The Guardian. Retrieved 3 July 2008.
  11. "The NHS Plan: a plan for investment, a plan for reform". The Department of Health. Retrieved 3 July 2008.
  12. "Labour hails fall in MRSA cases". BBC news. 7 March 2005. Retrieved 28 February 2008.
  13. "NHS trust warned over hygiene breaches". London: The Telegraph. 7 February 2008. Retrieved 30 March 2008.
  14. The Lancet (September 2007). "The traditional white coat: goodbye, or au revoir?". The Lancet. 370 (9593): 1102. doi:10.1016/S0140-6736(07)61487-1. PMID 17905145.
  15. "Hospital deep cleaning under fire". BBC News. 14 January 2008. Retrieved 30 March 2008.
  16. "Hospital deep clean target missed". BBC News. 29 March 2008. Retrieved 30 March 2008.
  17. "NHS trusts 'failing on hygiene'". BBC news. 15 June 2008. Retrieved 16 June 2008.
  18. Andrew Moore (6 October 2000). "Waste in the NHS: the problem, its size, and how we can tackle it". Balliol College, Oxford. Archived from the original on 11 June 2008. Retrieved 26 March 2008.
  19. "Johnson: Recruitment reform bungled". Channel 4 News. 25 July 2007. Retrieved 2 September 2008.
  20. Hawkes, Nigel (22 May 2007). "Health Department 'broke law over doctors' job test scores'". London: Times Online. Retrieved 26 March 2008.
  21. "Review into doctor recruitment". BBC news. 7 March 2007. Retrieved 26 March 2008.
  22. John Carvel (16 May 2007). "Hewitt backs down in junior doctor row". London: The Guardian. Retrieved 26 March 2008.
  23. "Hewitt 'misled Commons' over MTAS". Channel 4. 19 May 2007. Retrieved 26 March 2008.
  24. Nigel Hawkes, Health Editor (8 January 2008). "Department of Health 'must be stripped of doctors' training role'". London: The Times. Retrieved 26 March 2008.
  25. Oxman AD, Sackett DL, Chalmers I, Prescott TE (December 2005). "A surrealistic mega-analysis of redisorganization theories". J R Soc Med. 98: 563–8. doi:10.1258/jrsm.98.12.563. PMC 1299350. PMID 16319441.
  26. "Department of Health's CIO Company Profile | CIO UK". Cio.co.uk. Retrieved 4 December 2017.
  27. King, Leo (4 January 2010). "Tories vow NHS IT and management is 'number one priority'". Cio.co.uk. Retrieved 4 December 2017.
  28. King, Leo (14 December 2009). "NHS study damns electronic patient records systems". Cio.co.uk. Retrieved 4 December 2017.
  29. Knights, Miya (4 December 2006). "Technology high on transport review agenda". Cio.co.uk. Retrieved 4 December 2017.
  30. King, Leo (7 December 2009). "Chancellor threatens future of NHS IT programme". Cio.co.uk. Retrieved 4 December 2017.
  31. http://www.intellectuk.org/blog/tag/christine-connelly/
  32. "Archived copy". Archived from the original on 18 May 2011. Retrieved 13 May 2011.CS1 maint: archived copy as title (link)
  33. "Archived copy". Archived from the original on 10 July 2011. Retrieved 12 September 2011.CS1 maint: archived copy as title (link)
  34. "Scotland Act 1998, Schedule 5, Part II". Opsi.gov.uk. Retrieved 4 December 2017.
  35. "Northern Ireland Act 1998, Schedule 3". Opsi.gov.uk. 25 June 1998. Retrieved 4 December 2017.
  36. TheyWorkForYou (13 July 2009). "House of Commons, Written answers and statements". Theyworkforyou.com. Retrieved 4 December 2017.
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