The Health and Social Care Act now coming into force will have profound and – it’s argued – damaging consequences for fairness in healthcare. The basis for NHS data now becomes care commissioning groups and that switch may undermine the availability of the information that’s vital for monitoring who gets to access services, where and how.
An article in the British Medical Journal argues that area based structures for collecting data and monitoring populations are going. Most information responsibilities switch to commissioning groups, based on GP practices, the boundaries of which are fluid and often ‘non-geographical’.
This loss of a population basis and responsibilities for comprehensive data collection and monitoring will help ‘make it almost impossible to take the action needed to tackle inequalities in health and in access to healthcare’. Till now, the administrative structure of the NHS in England has been based on resident populations within defined areas, often co-terminous with councils, allowing matching of data.
In future the basis will be GP practices. This could impede collection of routine health data and make it hard to monitor the effect of new legislation on the health of the population locally or nationally.
The case is argued in Dismantling the signposts to public health? NHS data under the Health and Social Care Act 2012, the article also available on the City University site. Its authors are Professor Allyson Pollock of Queen Mary University of London, Professor Alison Macfarlane of City University and Sylvia Godden, honorary senior research fellow at QMUL.
What will happen to the NHS architecture of public health observatories and collaborations, which produce detailed profiles of the health status of local areas, is not clear. Optimists may say that it is in the interests of the commissioners to have good knowledge of the people in their catchment. Much may depend on how much data is shared – and the electronic and security protocols that permit data sharing.
But the BMJ authors say a large obstacle has been put in the way of ‘integrating’ the pathway taken by a patient from GP to clinic or hospital.