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United Kingdom
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The Department of Health headquarters in Whitehall

The Department of Health (DH) is a department of the United Kingdom government but with responsibility for government policy for England alone on health, social care and the National Health Service (NHS). It is led by the Secretary of State for Health with two Ministers of State and three Parliamentary Under-Secretaries of State.

The DH carries out some of its work through arm's length bodies[1], including non-departmental public bodies and executive agencies such as the NHS Purchasing and Supply Agency (NHS PASA) and the Medicines and Healthcare products Regulatory Agency (MHRA).

In the other countries of the United Kingdom, responsibility for health and the management of their National Health Services falls under the jurisdiction of the devolved governments, namely:

Contents

History

The Department of Health was formally created in 1988, through The Transfer of Functions (Health and Social Security) Order 1988. Like many others, the department with responsibility for the nation's health has had different names and included other functions over time.[2]

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 in 1919 through the Ministry of Health Act, 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 current Department of Health.

Location

DH building at Quarry Hill, Leeds (known locally as 'The Pink Palace' and 'The Kremlin')

The official headquarters and Ministerial offices are in Richmond House, Whitehall, London. Many staff are in Skipton House, Elephant and Castle, London and were formerly in Alexander Fleming House and Hannibal House there. There are also many staff based in Quarry House in Leeds, in Wellington House near Waterloo station in London and in New King's Beam House near Blackfriars Bridge.

Ministerial team

The current ministers at the DH are:.[3]

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Shadow Secretaries

The Conservative Party's Shadow Secretary of State is Andrew Lansley MP.[4] The Liberal Democrat spokesman is Norman Lamb MP.[5]

Permanent Secretary

The Permanent Secretary at the Department of Health is Hugh Taylor. Following the resignation of the previous Permanent Secretary Sir Nigel Crisp in March 2006 a separate post of Chief Executive of the NHS has been recreated, this is held by David Nicholson.

Previous permanent secretaries:

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 Sir Liam Donaldson, appointed in 1998.
  • Chief Nursing Officer (CNO) — Christine Beasley CBE, appointed in 2004.
  • 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 Scientific Officer — Professor Sue Hill, appointed in 2002.

Criticism

Introduction of user charges for NHS services

The publication of Professor Lord Darzi's review of the NHS[6] prompted criticism of the government and the department of health for paving the way for user charging[7], 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"[8]. The report also introduces the concept of 'personal budgets'.

Fragmentation of NHS services

Darzi's report[6] 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[7].

"Superbugs" and PFI

Fatal outbreaks of antibiotic-resistant bacteria ("superbugs"), such as Methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile, in NHS hospitals[9] has led to criticism of the DH's decision to outsource cleaning via private finance initiative contracts as "cutting corners on cleaning"[10].

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[11], by the firms doing the work as an attempt to avoid paying for regular better cleaning[12], and by NHS managers as ineffective[12].

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[13], and as of June 2008 one in four NHS trusts was not meeting the government's standards on hygiene[14].

Prescribing

Its advice to primary care on prescribing drugs such as proton pump inhibitors has been criticised as wasteful[15].

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 MTAS. These changes left "29,193 junior doctors from the UK and overseas... chasing 15,600 posts..."[16] and resulted in accusations that the DH had broken the law by refusing to reveal scores to candidates[17]. Ultimately there was a judicial review and a boycott of the system by senior doctors across the country[18]. MTAS was eventually scrapped[19] 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[20]. Even after the abolition of MTAS, anger among the medical profession was widespread[citation needed], with the British Medical Association commenting of the DH response that "Not only is this response too late, it does not go far enough"[18].

The official government inquiry into MMC recommended that the responsibility for medical training be removed from the DH[21].

Information Technology

In recent years the Department of Health[22] and the NHS have come under considerable scrutiny for its use of IT[23]. Since being elected to power in 1997 the Labour government has sought to modernise the NHS through the introduction of IT. Although the policy is correct in aim, many claim its execution is lacking[24].

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.[25] Connelly left the DoH 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 DoH's website. That strategy, known as the National Programme for IT[26], 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.[27]

In January 2009, MPs slammed the DoH for its confidentiality agreement with key supplier CSC and in March the Department was admonished by the Information Commissioner for its records management.

See also

References

  1. ^ Arm's length bodies of the Department of Health
  2. ^ "Health Departments". www.ndad.nationalarchives.gov.uk. The National Archives. http://www.ndad.nationalarchives.gov.uk/AH/21/detail.html. Retrieved 2006-11-07. 
  3. ^ Department of Health Ministers
  4. ^ House of Commons Information Office (8 September 2009). "Her Majesty's Official Opposition". UK Parliament. http://www.parliament.uk/mpslordsandoffices/government_and_opposition/opp.cfm. Retrieved 25 November 2009. 
  5. ^ House of Commons Information Office (13 July 2009). "Liberal Democrat Shadow Cabinet and Parliamentary Team". UK Parliament. http://www.parliament.uk/mpslordsandoffices/government_and_opposition/libdems.cfm. Retrieved 25 November 2009. 
  6. ^ a b Professor Lord Darzi KBE (2008-06-30). "High Quality Health Care For All" (pdf). The Department of Health. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_085825?IdcService=GET_FILE&dID=168197&Rendition=Web. Retrieved 2008-07-03. 
  7. ^ a b Allyson Pollock (2008-07-01). "Lord Darzi's report paves the way for Labour to charge for NHS care". The Guardian. http://www.guardian.co.uk/commentisfree/2008/jul/01/nhs.health1. Retrieved 2008-07-03. 
  8. ^ "The NHS Plan: a plan for investment, a plan for reform". The Department of Health. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4002960. Retrieved 2008-07-03. 
  9. ^ "Labour hails fall in MRSA cases". BBC news. 2005-03-07. http://news.bbc.co.uk/1/hi/health/4324281.stm. Retrieved 2008-02-28. 
  10. ^ "NHS trust warned over hygiene breaches". The Telegraph. 2008-02-07. http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2008/02/05/nhygiene105.xml. Retrieved 2008-03-30. 
  11. ^ Thelancet, (2007). "The traditional white coat: goodbye, or au revoir?". Lancet 370 (9593): 1102. doi:10.1016/S0140-6736(07)61487-1. PMID 17905145. 
  12. ^ a b "Hospital deep cleaning under fire". BBC News. 2008-01-14. http://news.bbc.co.uk/1/hi/health/7181837.stm. Retrieved 2008-03-30. 
  13. ^ "Hospital deep clean target missed". BBC News. 2008-03-29. http://news.bbc.co.uk/1/hi/health/7319160.stm. Retrieved 2008-03-30. 
  14. ^ "NHS trusts 'failing on hygiene'". BBC news. 2008-06-15. http://news.bbc.co.uk/1/hi/health/7453037.stm. Retrieved 2008-06-16. 
  15. ^ Andrew Moore (2000-10-06). "Waste in the NHS: the problem, its size, and how we can tackle it". Balliol College, Oxford. http://www.jr2.ox.ac.uk/bandolier/bandopubs/RAMnhsfu/NHSfutur.html. Retrieved 2008-03-26. 
  16. ^ "Johnson: Recruitment reform bungled". Channel 4 News. 2007-07-25. http://www.channel4.com/news/articles/society/health/johnson+recruitment+reform+bungled/625757. Retrieved 2008-09-02. 
  17. ^ "Health Department ‘broke law over doctors’ job test scores’". London: Times Online. 2007-05-22. http://www.timesonline.co.uk/tol/news/politics/article1821521.ece. Retrieved 2008-03-26. 
  18. ^ a b "Review into doctor recruitment". BBC news. 2007-03-07. http://news.bbc.co.uk/1/hi/health/6423307.stm. Retrieved 2008-03-26. 
  19. ^ John Carvel (2007-05-16). "Hewitt backs down in junior doctor row". The Guardian. http://www.guardian.co.uk/uk/2007/may/16/politics.health. Retrieved 2008-03-26. 
  20. ^ "Hewitt 'misled Commons' over MTAS". Channel 4. 2007-05-19. http://www.channel4.com/news/articles/society/health/hewitt+misled+commons+over+mtas/519657. Retrieved 2008-03-26. 
  21. ^ Nigel Hawkes, Health Editor (2008-01-08). "Department of Health ‘must be stripped of doctors’ training role’". London: The Times. http://www.timesonline.co.uk/tol/news/politics/article3149316.ece. Retrieved 2008-03-26. 
  22. ^ http://www.cio.co.uk/cio100/department-of-health/4156/
  23. ^ http://www.cio.co.uk/news/3209439/tories-vow-nhs-it-and-management-is-number-one-priority/
  24. ^ http://www.cio.co.uk/news/3208648/nhs-study-damns-electronic-patient-records-systems/
  25. ^ http://www.cio.co.uk/article/351/granger-the-final-word/?otc=44
  26. ^ http://www.cio.co.uk/news/3208249/chancellor-threatens-future-of-nhs-it-programme/
  27. ^ http://www.intellectuk.org/blog/tag/christine-connelly/

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