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      Commissioning for health improvement following the 2012 health and social care reforms in England: what has changed?

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          Abstract

          Background

          The wide-ranging program of reforms brought about by the Health and Social Care Act (2012) in England fundamentally changed the operation of the public health system, moving responsibility for the commissioning and delivery of services from the National Health Service to locally elected councils and a new national public health agency. This paper explores the ways in which the reforms have altered public health commissioning.

          Methods

          We conducted multi-methods research over 33 months, incorporating national surveys of Directors of Public Health and local council elected members at two time-points, and in-depth case studies in five purposively selected geographical areas.

          Results

          Public health commissioning responsibilities have changed and become more fragmented, being split amongst a range of different organisations, most of which were newly created in 2013. There is much change in the way public health commissioning is done, in who is doing it, and in what is commissioned, since the reforms. There is wider consultation on decisions in the local council setting than in the NHS, and elected members now have a strong influence on public health prioritisation. There is more (and different) scrutiny being applied to public health contracts, and most councils have embarked on wide-ranging changes to the health improvement services they commission. Public health money is being used in different ways as councils are adapting to increasing financial constraint.

          Conclusions

          Our findings suggest that, while some of the intended opportunities to improve population health and create a more joined-up system with clearer leadership have been achieved, fragmentation, dispersed decision-making and uncertainties regarding funding remain significant challenges. There have been profound changes in commissioning processes, with consequences for what health improvement services are ultimately commissioned. Time (and further research) will tell if any of these changes lead to improved population health outcomes and reduced health inequalities, but many of the opportunities brought about by the reforms are threatened by the continued flux in the system.

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          Most cited references 26

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          The world health report 2000 - Health systems: improving performance

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            The problem of fragmentation and the need for integrative solutions.

             Kurt C Stange (2015)
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              Healthy Lives, Healthy People: Our Strategy for Public Health in England

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                Author and article information

                Contributors
                01227 827576 , E.Gadsby@kent.ac.uk
                S.Peckham@kent.ac.uk
                Anna.J.Coleman@manchester.ac.uk
                Donna.Bramwell@manchester.ac.uk
                L.M.Jenkins@kent.ac.uk
                Journal
                BMC Public Health
                BMC Public Health
                BMC Public Health
                BioMed Central (London )
                1471-2458
                17 February 2017
                17 February 2017
                2017
                : 17
                Affiliations
                [1 ]ISNI 0000 0001 2232 2818, GRID grid.9759.2, Centre for Health Services Studies, , University of Kent, ; Canterbury, UK
                [2 ]ISNI 0000000121662407, GRID grid.5379.8, Centre for Primary Care, , University of Manchester, ; Manchester, UK
                Article
                4122
                10.1186/s12889-017-4122-1
                5316188
                28212638
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                Funding
                Funded by: UK Department of Health
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2017

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