Department of Health (United Kingdom)

Department of Health
Logo of the Department of Health
Department overview
Formed	1988
Preceding Department	Department of Health and Social Security
Jurisdiction	England
Headquarters	London, England
Ministers responsible	Andrew Lansley MP, Secretary of State for Health Simon Burns MP, Minister of State for Health Paul Burstow MP, Minister of State for Care Services
Department executives	Una O'Brien, Permanent Secretary David Nicholson, Chief Executive of the NHS
Website
www.dh.gov.uk

United Kingdom

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The Department of Health (DH) is a department of the United Kingdom government with responsibility for government policy for health and social care matters and for the National Health Service (NHS) in England along with a few elements of the same matters which are not otherwise devolved to the Scottish, Welsh or Northern Irish governments. It is led by the Secretary of State for Health with two Ministers of State and two Parliamentary Under-Secretaries of State.

The role that the department of health plays is a role of overall introducing policies and guidelines which then improve the quality of care and they also help meet patient’s standards.

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 Commercial Medicines Unit (CMU) 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 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.

Abbreviation

Upon de-merger from the DHSS the Department of Health was commonly abbreviated in internal Governmental correspondence to 'DoH', which was also used in staff email address endings (@doh.gsi.gov.uk). This was changed to DH, omitting the 'o', circa 2004, unwritten internal sources suggesting that the original abbreviation may be uncomfortably close to Homer Simpson's expression of disdain "D'oh!". DH is now the abbreviation used in correspondence, official email addresses and URLs, although a number of health media outlets continue to favour the previous abbreviation.

Location

The Department of Health headquarters in Whitehall

The official headquarters and ministerial offices are in Richmond House (Whitehall, London). Other London locations include Skipton House (Elephant and Castle), Wellington House near Waterloo station and New King's Beam House near Blackfriars Bridge. Alexander Fleming House and Hannibal House were previously used by the department. In addition, staff are based in Quarry House in Leeds,

Ministers

The Department of Health Ministers are as follows:^[3]

Minister		Rank	Portfolio
	The Rt Hon Andrew Lansley CBE MP	Secretary of State	Overall responsibility
	The Rt Hon Simon Burns MP	Minister of State	Health services
	Paul Burstow MP	Minister of State	Care services, mental health, disabilities
	Anne Milton MP	Parliamentary Under Secretary of State	Public health, devolved matters
	The Earl Howe	Parliamentary Under Secretary of State	Quality, NHS Constitution, primary care, medicines

Key		Conservative
		Liberal Democrat

Permanent Secretary

The current Permanent Secretary at the Department of Health is Una O'Brien. 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:

• Sir Hugh Taylor KCB 2006-2010
• Sir Nigel Crisp KCB 2000-2006
• Sir Christopher Kelly KCB 1997-2000
• Sir Graham Hart KCB 1992-?
• Sir Christopher France, (DHSS including social security: 1987-1988, DH: 1987-1992)
• Sir Kenneth Stowe GCB CVO 1981-1987 (DHSS)

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 Dame Sally Davies, appointed in 2011.
• Chief Nursing Officer (CNO) — Christine Beasley CBE, appointed in 2004.
• 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.

Criticism

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

Introduction of user charges for NHS services

The publication of Professor Lord Darzi's review of the NHS^[4] prompted criticism of the government and the department of health for paving the way for user charging,^[5] 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".^[6] The report also introduces the concept of 'personal budgets'.

Fragmentation of NHS services

Darzi's report^[4] 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.^[5]

"Superbugs" and PFI

Fatal outbreaks of antibiotic-resistant bacteria ("superbugs"), such as Methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile, in NHS hospitals^[7] has led to criticism of the DH's decision to outsource cleaning via private finance initiative contracts as "cutting corners on cleaning".^[8]

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,^[9] by the firms doing the work as an attempt to avoid paying for regular better cleaning,^[10] and by NHS managers as ineffective.^[10]

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,^[11] and as of June 2008 one in four NHS trusts was not meeting the government's standards on hygiene.^[12]

Prescribing

Its advice to primary care on prescribing drugs such as proton pump inhibitors has been criticised as wasteful.^[13]

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..."^[14] and resulted in accusations that the DH had broken the law by refusing to reveal scores to candidates.^[15] Ultimately there was a judicial review and a boycott of the system by senior doctors across the country.^[16] MTAS was eventually scrapped^[17] and Patricia Hewitt, the then Secretary of State for Health, resigned^{[clarification needed]} following accusations that she had lied to the House of Commons over the system.^[18] 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".^[16]

The official government inquiry into MMC recommended that the responsibility for medical training be removed from the DH.^[19]

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'.^[20] 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 extenet completing the job started under the Blair administration.

Information technology

In recent years the Department of Health^[21] and the NHS have come under considerable scrutiny for its use of IT.^[22] 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.^[23]

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.^[24] 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,^[25] 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.^[26]

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.^[27]

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)^[28] 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:

• the Scottish Government Health and Wellbeing Directorate
• the Welsh Assembly Government
• the Department of Health, Social Services and Public Safety, Northern Ireland Executive

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

Scotland ^[29]

• regulation of the health professions
• abortion
• xenotransplantation
• embryology, surrogacy and human genetics
• medicines, medical supplies and poisons

Northern Ireland ^[30]

• xenotransplantation
• surrogacy
• human fertilisation and embryology
• human genetics

In Northern Ireland, abortion law is a criminal justice matter and is devolved.^[31]

Wales

Under the Welsh devolution settlement, specific policy areas are transferred to the National Assembly for Wales 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 NHS Wales.

See also

• Government of England
• United Kingdom budget
• Healthcare in the United Kingdom

References

1. ^ Arm's length bodies of the Department of Health
2. ^ "Health Departments". ndad.nationalarchives.gov.uk. The National Archives. http://www.ndad.nationalarchives.gov.uk/AH/21/detail.html. Retrieved 2006-11-07. 
3. ^ Cabinet Office List of Government Departments and Ministers: Department of Health
4. ^ ^{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. 
5. ^ ^{a b} Allyson Pollock (2008-07-01). "Lord Darzi's report paves the way for Labour to charge for NHS care". London: The Guardian. http://www.guardian.co.uk/commentisfree/2008/jul/01/nhs.health1. Retrieved 2008-07-03. 
6. ^ "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. 
7. ^ "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. 
8. ^ "NHS trust warned over hygiene breaches". London: The Telegraph. 2008-02-07. http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2008/02/05/nhygiene105.xml. Retrieved 2008-03-30. 
9. ^ Thelancet, (2007). "The traditional white coat: goodbye, or au revoir?". Lancet 370 (9593): 1102. doi:10.1016/S0140-6736(07)61487-1. PMID 17905145. 
10. ^ ^{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. 
11. ^ "Hospital deep clean target missed". BBC News. 2008-03-29. http://news.bbc.co.uk/1/hi/health/7319160.stm. Retrieved 2008-03-30. 
12. ^ "NHS trusts 'failing on hygiene'". BBC news. 2008-06-15. http://news.bbc.co.uk/1/hi/health/7453037.stm. Retrieved 2008-06-16. 
13. ^ 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. 
14. ^ "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. 
15. ^ Hawkes, Nigel (2007-05-22). "Health Department ‘broke law over doctors’ job test scores’". London: Times Online. http://www.timesonline.co.uk/tol/news/politics/article1821521.ece. Retrieved 2008-03-26. 
16. ^ ^{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. 
17. ^ John Carvel (2007-05-16). "Hewitt backs down in junior doctor row". London: The Guardian. http://www.guardian.co.uk/uk/2007/may/16/politics.health. Retrieved 2008-03-26. 
18. ^ "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. 
19. ^ 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. 
20. ^ http://www.ncbi.nlm.nih.gov/pubmed/16319441
21. ^ http://www.cio.co.uk/cio100/department-of-health/4156/
22. ^ http://www.cio.co.uk/news/3209439/tories-vow-nhs-it-and-management-is-number-one-priority/
23. ^ http://www.cio.co.uk/news/3208648/nhs-study-damns-electronic-patient-records-systems/
24. ^ http://www.cio.co.uk/article/351/granger-the-final-word/?otc=44
25. ^ http://www.cio.co.uk/news/3208249/chancellor-threatens-future-of-nhs-it-programme/
26. ^ http://www.intellectuk.org/blog/tag/christine-connelly/
27. ^ http://www.silicon.com/technology/software/2011/05/13/nhs-patient-records-project-faces-axe-says-cameron-39747397/
28. ^ http://www.communitycare.co.uk/Articles/2011/02/02/116215/civil-service-cuts-put-mental-health-strategy-at-risk.htm
29. ^ Scotland Act 1998, Schedule 5, Part II
30. ^ Northern Ireland Act 1998, Schedule 3
31. ^ House of Commons, Written answers and statements, 13 July 2009

External links

• Department of Health

Video clips

• Department of Health YouTube channel