The Health and Social Care Act 2012 will have “severe implications” for collecting and monitoring data about the health needs of the population in England, warn experts

In a paper published on bmj.com, Professor Allyson Pollock, Professor Alison Macfarlane and Sylvia Godden argue that the new legislation will make it “extremely difficult” to monitor health inequalities and access to care locally or nationally.

The administrative structure of the NHS in England is currently based on resident populations of defined geographical areas. Under the new legislation, most health services will transfer to non-geographically based clinical commissioning groups (CCGs) that will be able to recruit patients living anywhere in England.

This, warn the authors, is likely to lead to erosion of data quality, accuracy, and completeness.

For example, responsibility for services such as childhood immunisation, HIV and sexual health, and mental health will be located in local authorities. Since local authority residents may be registered with any one of a number of different CCGs, the local authority will have to subcontract these services to a CCG, which could in turn outsource them to several providers.

Although it will be possible to compare differences between CCGs, “the instability of the denominator population will hinder accurate interpretation of the data,” say the authors.

Cancer registries will also be affected, while increased outsourcing of care to private providers creates problems with the quality, completeness, and accuracy of coding of data, they add.

Finally, they argue that the transfer of resources and NHS staff to the private sector means that they will no longer be counted in NHS bed availability and workforce statistics, creating problems for long term planning.

They conclude: “The NHS is founded on the principle of comprehensive coverage. Equitable public health activity requires reliable information. The abolition of area based structures and the transfer of most responsibilities to non-geographically based CCGs, as well as some responsibilities to local authorities, undermines the availability of information and routine data required to monitor the comprehensiveness of the health service, inequalities in access, the resourcing of services, and outcomes of care.
“Private income generation coupled with the loss of the NHS’ population basis and responsibilities for comprehensive data collection and monitoring will make it almost impossible to take the action needed to tackle inequalities in health and in access to healthcare.”

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The Government has tabled a series of amendments to the Health and Social Care Bill in advance of its Report Stage in the House of Lords, which begins next week.

Health Minister Earl Howe has tabled a number of amendments that reaffirm the Government’s commitment to putting patients at the heart of the NHS and handing power to GPs and nurses. Alongside the amendments, the Department of Health has also pubished a set of briefing notes.

The amendments include:

• Secretary of State accountability: Putting beyond doubt the Secretary of State’s responsibility and accountability with respect to a comprehensive health service. These amendments follow constructive cross-party discussion about this issue.
• Greater patient involvement: Patients will have a greater say in their health, with the NHS Commissioning Board and clinical commissioning groups having stronger duties to promote patient involvement in their own care.
• Education and training: The NHS Commissioning Board and clinical commissioning groups will have new responsibilities to support education and training, strengthening the links between workforce planning and education and training.
• Health inequalities: A new duty on the Secretary of State, NHS Commissioning Board and clinical commissioning groups to report annually on their progress in tackling health inequalities.
• Strengthening integration: Making clear that the health regulator Monitor will have the power to require healthcare providers to promote integration of NHS services.

See amendments and briefing notes.

Health Secretary Andrew Lansley said: ‘The principles of our modernisation plans – “no decision about me, without me” for patients, clinical leadership with doctors and nurses leading discussions on services, a focus on results for patients and reducing bureaucracy – have always been at the core of the Bill. These principles are widely accepted as reported by the independent NHS Future Forum. But we have been carefully listening to the ideas raised as the Bill has progressed through Parliament. And as a result we have today tabled a series of amendments to address these remaining issues.’

Report stage in the House of Lords is due to start on 8 February.

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