Many people (myself included) would never have thought they would see the Health and Social Care Act passed given uneasy passage of the Bill through Parliament. The legislation, the largest since the inception of the NHS in 1948 underwent approximately 2 000 amendments and over 50 days of debate before it was passed, and, though some aspects of the bill are needed, many remain challenged by professional bodies, some of whom have called for its abolition, and raise concerns concerning the transition from the old to the new. Now begins the process of embedding the legislation, the Government has already indicated less central control, more devolution of power and and an increase in local accountability with strategic decision making powers that direct service provision and the allocation of budgets locally—what is not clear yet however, is how to accomplish this. Paramedics should remain aware of the changes being made, not only how this impacts them directly, but also the repercussions upon health and social services and patients overall.
The health and social care systems now have the challenging task of implementing amendments for the statutory changes in time for April 2013, along with an altered relationship with local government and a relocation of key aspects of care provision as well as the formation of health and wellbeing boards. What must remain clear, is that the NHS is not abdicating its responsibilities; it must and will continue to serve the public through its fundamental duties, enhancing health and wellbeing, and preventing disease.
Across England, prospective CCGs are operating under delegated arrangements with PCTs, patients have already been offered more choice and data about service provision. The Act’s reforms have the ability to force a more integrated approach to care provision strengthening current multidisciplinary and care sector partnerships.
The way managers in the service handle the movement of people between the old and new systems will be critical for a successful transition, and these people (clinicians, managers etc.) shall be the basis of success now and in the future. It is therefore essential to invest in the most important resource, namely the human resource. Managers have a responsibility to promote meritocracy, and the crucial intention of managing the transition successfully will be to continue to provide a quality, safe and effective ambulance service, with the needs of patients at its heart. During the transition, there will be an inevitable balancing act for individuals as new processes and procedures overlap and in some cases may contradict.
Undoubtedly, there will be tension between the old and new systems, as well as tension between delivering for today while constructing for tomorrow. Such tensions must be managed sensibly, focussing on the objectives of the changes being made in delivering outstanding, patient-centred outcomes for the people we have the privilege to care for, our patients. This overriding goal will require all parties to work together and to build upon a national health service and associated systems that will continue to deliver excellence in all that they offer. Opportunities provided by the Act to strengthen service provision will affect clinicians, managers, patients and the public, but the challenges too should not be ignored. For example, future fnancial uncertainty is set to be a major concern for the issue of competition and collaboration, a key feature of the Act.
Paramedics have a role embedding the key messages of this Health and Social Care Act, setting up new structures and monitoring and commenting on their own input as well as upon the input of others. Time will tell if the Act has been successful in bettering public health, wellbeing and fundamentally, providing a health service that is free at the point of need, safe, effective and that meets local demands.