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Department of Health and Social Care

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The Department of Health and Social Care (DHSC) is a ministerial department of the Government of the United Kingdom. It is responsible for government policy on health and adult social care matters in England, along with a few elements of the same matters which are not otherwise devolved to the Scottish Government, Welsh Government or Northern Ireland Executive. It oversees the English National Health Service (NHS). The department is led by the Secretary of State for Health and Social Care with three ministers of state and three parliamentary under-secretaries of state.

Department of Health and Social Care
Logo

39 Victoria Street, Westminster
Department overview
Formed1988
Preceding Department
JurisdictionGovernment of the United Kingdom
Headquarters39 Victoria Street
London
SW1H 0EU[1]
Employees1,588 (2019/20)[2]
Annual budget£138.9 billion; 2020–21 ($185 billion)[3]
Secretary of State responsible
Department executive
Websitewww.gov.uk/government/organisations/department-of-health-and-social-care Edit this at Wikidata

The department develops policies and guidelines to improve the quality of care and to meet patient expectations. It carries out some of its work through arms-length bodies (ALBs),[4] including executive non-departmental public bodies such as NHS England and the NHS Digital, and executive agencies such as the UK Health Security Agency and the Medicines and Healthcare products Regulatory Agency (MHRA). The DHSC also manages the work of the National Institute for Health and Care Research (NIHR).[5]

The expenditure, administration and policy of the department are scrutinised by the Health and Social Care Select Committee.[6]

History

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Like many others, the department with responsibility for the nation's health has had different names and has included other functions at different times.[7]

In the 19th century, several bodies were formed for specific consultative duties and were dissolved when they were no longer required. There were two incarnations of a Board of Health, in 1805 and 1831, and from 1854 to 1858 a General Board of Health reported directly to the Privy Council. Responsibility for health issues was also in part vested in local health boards, which existed from 1848 to 1894. In 1871, the Local Government Board was created to supervise such local functions as health and sanitation and also took over the functions of the Poor Law Board, which was abolished. The Public Health Act 1875 (38 & 39 Vict. c. 55) designated sanitary districts, which by the Local Government Act 1894 became rural and urban district councils. With the emergence of modern local government, some of its supervision was done by the Local Government Act Office, part of the Home Office.[citation needed]

The Ministry of Health Act 1919 abolished the Local Government Board and transferred its powers and duties to a new department called the Ministry of Health, which consolidated under a single authority the medical and public health functions of central government. This took on the medical duties of the Board of Education, the duties of the Privy Council under the Midwives Acts, the powers of the Home Secretary in relation to the Children Act 1908 (8 Edw. 7. c. 67), and the duties of the Insurance Commissioners and the Welsh Insurance Commissioners. In the early part of the 20th century, medical assistance had been provided through these National Health Insurance Commissions. Most of the Local Government Board staff transferred to the new ministry.[citation needed]

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.[8] [9]

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, in 1988, these functions were split back into two government departments, forming the Department of Social Security (DSS) and the Department of Health, formally created in through The Transfer of Functions (Health and Social Security) Order 1988.[citation needed]

Following the 2018 British cabinet reshuffle, the department was renamed the Department of Health and Social Care.[10]

Location

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The department's headquarters and ministerial offices are at 39 Victoria Street, London. The department moved from its previous location in Richmond House, Whitehall in November 2017. Its other principal offices are Skipton House (Elephant and Castle), Wellington House near Waterloo station and Quarry House in Leeds. Wellington House is now mainly occupied by staff from the department's arms-length bodies. New King's Beam House near Blackfriars Bridge was formerly a Department of Health office prior to the expiry of its lease in October 2011. Alexander Fleming House, Hannibal House and Eileen House [11] (all in Elephant and Castle) were previously used by the department. The archives are at Nelson, Lancashire.[citation needed]

Ministers

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The Department of Health and Social Care's ministers are as follows, with cabinet ministers in bold:

Minister Portrait Office Portfolio
The Rt Hon. Wes Streeting MP   Secretary of State for Health and Social Care The Secretary of State is responsible for the work of the Department of Health and Social Care, including:

- overall financial control and oversight of NHS delivery and performance
- oversight of social care policy

The Hon. Stephen Kinnock MP   Minister of State for Social Care Adult social care (workforce, funding, system assurance and data, markets, technology and innovation, continuing healthcare); hospital and community discharge; health and social care integration; dementia; primary care (general practice, pharmacy, eye care, dentistry); community health, including neighbourhood health services; end of life and palliative care; disabilities and SEND (special educational needs and disabilities)
Karin Smyth MP   Minister of State for Health System oversight (system reconfigurations and improvement, commissioning); elective care (elective performance and waiting list recovery, cancer care); NHS workforce (recruitment and retention, education and training, leadership, pay and pensions, industrial relations, professional regulation); NHS data and technology (cyber security, Federated Data Platform); NHS capital, land and estates (New Hospital Programme, hospital upgrades, reinforced autoclaved aerated concrete (RAAC), energy resilience and net zero, car parking); medicines (medicines regulation, pricing and supply, prescribing); supply threats and disruption; NHS finance( procurement, cost recovery and immigration health surcharge, counter fraud); urgent and emergency care (accident and emergency services, NHS 111 services, hospital at home services, ambulances, winter planning); sponsorship of NHS England, NHS Counter Fraud Authority, NHS Property Services, NHS Business Services Authority, Medicines and Healthcare products Regulatory Agency, National Institute for Health and Care Excellence
The Rt Hon. Baroness Merron   Parliamentary Under-Secretary of State for Mental Health and Women's Health Strategy Patient voice and patient experience (Patient Safety Commissioner, complaints, Healthwatch); patient safety (clinical negligence, inquiries, quality regulation, death certification, indemnity); mental health (mental health reform, children and young people and early intervention, suicide and crisis prevention, offender health, mental health inquiries); blood, transplant and organs; research (clinical trials, COVID-19 vaccine licensing, National Institute for Health and Care Research); life sciences and innovation (medtech and regulation, genomics); women’s health; maternity services; reproductive health; abortion; gender identity services; statutory instruments, including retained EU laws; departmental management; sponsorship of Health Research Authority, Care Quality Commission, Health Services Safety Investigations Body, NHS Resolution, Human Fertilisation and Embryology Authority, Human Tissue Authority, NHS Blood and Transplant
Andrew Gwynne MP   Parliamentary Under-Secretary of State for Public Health and Prevention Health protection (COVID-19, environmental health, infectious diseases, seasonal immunisations, routine immunisations, Vaccine Damage Payment Scheme, pandemic preparedness, emergency response, antimicrobial resistance, chemical, biological, radiological and nuclear threats); health improvement (diet and obesity, addiction, including tobacco, alcohol, drugs and gambling, NHS Health Check, health inequalities, child health and family services, work and health, sexual health, including HIV); international(World Health Organization and international engagement, EU and trade, devolved administrations, crown dependencies and overseas territories, overseas development aid programmes, including Public Health Rapid Support Team); major and long-term conditions (cancer prevention and strategy, diabetes, cardiovascular diseases, rare diseases, long-term conditions, screening); sponsorship of UK Health Security Agency, Food Standards Agency
vacant Parliamentary Under-Secretary of State System performance and operational efficiency; capital and estates
Sponsorship of NHS Accelerated Access Collaborative, NHS Business Services Authority

Permanent secretary

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The permanent secretary at the Department of Health and Social Care is Sir Christopher Wormald KCB, who was appointed in 2016. Previous permanent secretaries:[citation needed]

Following the resignation of Sir Nigel Crisp in March 2006, a separate post of Chief Executive of the National Health Service in England was created, held by Sir David Nicholson. Following the Health and Social Care Act 2012 and the creation of the independent NHS Commissioning Board, known as NHS England, this post has evolved into Chief Executive of the new organisation.[citation needed]

Chief professional officers

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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.[citation needed]

Position Holder Date of
appointment
Chief Medical Officer for England (CMO) Professor Chris Whitty Oct 2019
Chief Nursing Officer (CNO) Duncan Buryon 2024
Chief Scientific Officer (CSO) Professor Sue Hill OBE 2002
Chief Dental Officer for England (CDO) Jason Wong 2023
Chief Allied Health Professions Officer (CAHPO) Professor Suzanne Rastrick OBE 2014
Chief Pharmaceutical Officer David Webb 2022
Chief Social Worker for Adults Vacant
Chief Social Worker for Children and Families
(Role jointly under Department of Education).		 Isabelle Trowler 2013

Arms-length bodies (ALBs)

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The department acts as a 'steward' for the health and adult social care system in England and oversees fifteen arms-length bodies (ALBs):

Executive agencies

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The department has two executive agencies:[citation needed]

Executive non-departmental public bodies

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The department has thirteen executive non-departmental public bodies:[citation needed]

United Kingdom
  • The Human Tissue Authority regulates the use of human tissue in research and therapeutic treatments across the United Kingdom.
  • The Human Fertilisation and Embryology Authority, which regulates and inspects in vitro fertilisation, artificial insemination and the storage of human eggs, sperm or embryos. It also regulates human embryo research.
England and Wales
England only
  • The Care Quality Commission (CQC) has the primary function of inspecting providers of health and adult social care in England, ensuring that they meet essential standards of safety and quality.
  • NHS Digital, which provides statistical information and informatics support to the health and care system in England.
  • Health Education England is responsible for ensuring enough high-quality training is available to develop the healthcare workforce.
  • NHS England oversees the NHS in England, commissions specialised healthcare services and primary care services and oversees clinical commissioning groups and as of 1 April 2019 (formalised in June 2022,)[12] oversees NHS trusts and foundation trusts in England, due to a merger with NHS Improvement which itself was only formed in April 2016 by combining:
  • The Health Research Authority protects and promotes the interests of patients and the public in health research.
  • NHS Resolution, handles negligence claims and helps the NHS learn lessons from claims to improve patient and staff safety.
  • The NHS Counter Fraud Authority, tasked with leading the fight against NHS Fraud and corruption.

Criticism

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Quarry House: a DH building shared with the Department for Work and Pensions at Quarry Hill, Leeds (known locally as 'The Kremlin'[citation needed]).

Introduction of user charges for NHS services

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The publication of Professor Lord Darzi's review of the NHS[13] prompted criticism of the government and the Department of Health, claiming that it paved the way for user charging,[14] 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".[15] The report also introduces the concept of personal budgets.[citation needed]

Fragmentation of NHS services

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Darzi's report[13] 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.[14]

"Superbugs" and PFI

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Fatal outbreaks of antibiotic-resistant bacteria ("superbugs"), such as methicillin-resistant Staphylococcus aureus (MRSA) and Clostridioides difficile, in NHS hospitals[16] has led to criticism in 2008 of the department's decision to outsource cleaning via private finance initiative contracts as "cutting corners on cleaning".[17]

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,[18] by the firms doing the work as an attempt to avoid paying for regular better cleaning,[19] and by NHS managers as ineffective.[19]

It also attracted criticism because only a quarter of the £60m funding for the scheme went to hospitals,[clarification needed] and because a number of hospitals missed the completion target,[20] and as of June 2008 one in four NHS trusts was not meeting the government's standards on hygiene.[21]

Prescribing

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Its advice to primary care on prescribing drugs such as proton pump inhibitors has been criticised as wasteful.[22]

Medical training

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The DH has attracted criticism for its 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..."[23] and resulted in accusations that the DH had broken the law by refusing to reveal scores to candidates.[24] Ultimately there was a judicial review and a boycott of the system by senior doctors across the country.[25] MTAS was eventually scrapped[26] 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.[27] 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".[25]

The official government inquiry into MMC recommended that the responsibility for medical training be removed from the DH.[28]

Recurrent NHS reorganisation

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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,[clarification needed] small area primary care trusts (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'.[29]

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 extent completing the job started under the Blair administration. The NHS as of 1 April 2013 is no longer situated within the DH, as NHS England also went 'live' at the same time. Therefore, the DH has a further scrutiny role of NHS services and commissioning.[citation needed]

Information technology

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In recent years the Department of Health[30] and the NHS have come under considerable scrutiny for its use of IT.[31] Since being elected to power in 1997 the Labour government had sought to modernise the NHS through the introduction of IT. Although the policy is correct in aim, many claim its execution is lacking.[32]

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.[33] Connelly left the DH for a position in the Cabinet Office in June 2009 and was replaced by Tim Donohoe and Carol Clarke.[citation needed]

Connelly's role was to "deliver the Department's overall information strategy and integrating leadership across the NHS", according to the DH's website. That strategy, known as the National Programme for IT,[34] 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.[needs update]

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" sites in the south of England and offer toolkits by March 2010 to allow more local configuration of systems.[35]

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.[36]

In 2022 Sajid Javid launched the Plan for Digital Health and Social Care, which includes "regulatory levers" will be used to: "signal that digitisation is a priority, identify the non-negotiable standards of digital capability, [and] explain how we will monitor and support compliance". Integrated care systems will be required to put in place a joined-up health and social care record by March 2025 in which all clinical teams will have access to a complete view of a person's record that they can contribute to. In 2022 86% of trusts had "some form of electronic patient record" but only 45% of social care providers used a digital social care record, and 23% of care home staff cannot access the internet consistently. The NHS app is to be a "digital front door" for patients, with increasing functionality to be added and remote consultations with GPs are to be encouraged.[37] £25 million is to be provided in 2022/23 to support the rapid digitisation of social care, including adopting Digital Social Care Records.[38]

2010–11 staffing cuts

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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[vague] staffing reductions.[citation needed] In order to minimise redundancy costs,[citation needed] the predominant impact was upon DH staff not employed through a traditional civil service 'headcount' contract, with a resultant 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)[39] and the withdrawal of the practical assistance available to the NHS and local authorities via the national support teams.[citation needed]

Devolution

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Most health policy in Scotland, Wales and Northern Ireland is devolved to the department's counterparts:[40]

The comparability factor (the proportion of spending in this area which is devolved) was 99.5% for all three countries for 2021/22.[41]

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

Scotland

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[42]

Northern Ireland

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[43]

In Northern Ireland, abortion law is a criminal justice matter and is devolved.[44]

Wales

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[45]

See also

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References

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  1. ^ "Department of Health and Social Care". gov.uk. Retrieved 4 December 2019.
  2. ^ "Department of Health and Social Care Annual Report and Accounts 2019-20 (For the period ended 31 March 2020)" (PDF). GOV.UK. Retrieved 21 March 2021.
  3. ^ Spending Round 2019. London: HM Treasury. 4 September 2019. Retrieved 20 November 2020.
  4. ^ "[Withdrawn] Arm's length bodies". GOV.UK. 7 July 2014. Retrieved 4 December 2017.
  5. ^ "Our governance". NIHR. Retrieved 17 March 2022.
  6. ^ "Role - Health and Social Care Committee". parliament.uk. Retrieved 12 March 2022. The Health and Social Care Committee is appointed by the House of Commons to examine the policy, administration and expenditure of the Department of Health and Social Care and its associated bodies.
  7. ^ "Health Departments". ndad.nationalarchives.gov.uk. The National Archives. Archived from the original on 6 November 2006. Retrieved 7 November 2006.
  8. ^ Paul Addison, "The Road to 1945", Jonathan Cape, 1975, pp. 178–81.
  9. ^ Tony, Delamothe (2008). "NHS at 60: Founding principles". BMJ (Clinical Research Ed.). 336 (7655). BMJ: 1216–1218. doi:10.1136/bmj.39582.501192.94. PMC 2405823. PMID 18511796.
  10. ^ Mikey Smith (8 January 2018). "Jeremy Hunt has got a new job in Theresa May's Cabinet reshuffle after an hour inside Number 10". Daily Mirror.
  11. ^ "43-storey housing tower planned for Newington Causeway". London SE1 News. 7 March 2009. Retrieved 21 April 2021.
  12. ^ "NHS Improvement". www.gov.uk. 9 November 2021. Retrieved 26 August 2022.
  13. ^ a b Professor Lord Darzi KBE (30 June 2008). "High Quality Health Care For All" (PDF). The Department of Health. Retrieved 3 July 2008.
  14. ^ a b Allyson Pollock (1 July 2008). "Lord Darzi's report paves the way for Labour to charge for NHS care". The Guardian. London. Retrieved 3 July 2008.
  15. ^ "The NHS Plan: a plan for investment, a plan for reform". The Department of Health. Retrieved 3 July 2008.
  16. ^ "Labour hails fall in MRSA cases". BBC News. 7 March 2005. Retrieved 28 February 2008.
  17. ^ "NHS trust warned over hygiene breaches". London: The Telegraph. 7 February 2008. Retrieved 30 March 2008.[dead link‍]
  18. ^ The Lancet (September 2007). "The traditional white coat: goodbye, or au revoir?". The Lancet. 370 (9593): 1102. doi:10.1016/S0140-6736(07)61487-1. PMID 17905145. S2CID 38143608.
  19. ^ a b "Hospital deep cleaning under fire". BBC News. 14 January 2008. Retrieved 30 March 2008.
  20. ^ "Hospital deep clean target missed". BBC News. 29 March 2008. Retrieved 30 March 2008.
  21. ^ "NHS trusts 'failing on hygiene'". BBC News. 15 June 2008. Retrieved 16 June 2008.
  22. ^ Andrew Moore (6 October 2000). "Waste in the NHS: the problem, its size, and how we can tackle it". Balliol College, Oxford. Archived from the original on 11 June 2008. Retrieved 26 March 2008.
  23. ^ "Johnson: Recruitment reform bungled". Channel 4 News. 25 July 2007. Retrieved 2 September 2008.
  24. ^ Hawkes, Nigel (22 May 2007). "Health Department 'broke law over doctors' job test scores'". London: Times Online. Retrieved 26 March 2008.[dead link‍]
  25. ^ a b "Review into doctor recruitment". BBC News. 7 March 2007. Retrieved 26 March 2008.
  26. ^ John Carvel (16 May 2007). "Hewitt backs down in junior doctor row". The Guardian. London. Retrieved 26 March 2008.
  27. ^ "Hewitt 'misled Commons' over MTAS". Channel 4. 19 May 2007. Retrieved 26 March 2008.
  28. ^ Hawkes, Nigel (8 January 2008). "Department of Health 'must be stripped of doctors' training role'". The Times. London. ISSN 0140-0460. Archived from the original on 26 July 2008. Retrieved 26 March 2008.
  29. ^ Oxman AD, Sackett DL, Chalmers I, Prescott TE (December 2005). "A surrealistic mega-analysis of redisorganization theories". J R Soc Med. 98 (12): 563–8. doi:10.1177/014107680509801223. PMC 1299350. PMID 16319441.
  30. ^ "Department of Health's CIO Company Profile | CIO UK". Cio.co.uk. Retrieved 4 December 2017.
  31. ^ King, Leo (4 January 2010). "Tories vow NHS IT and management is 'number one priority'". Cio.co.uk. Retrieved 4 December 2017.
  32. ^ King, Leo (14 December 2009). "NHS study damns electronic patient records systems". Cio.co.uk. Retrieved 4 December 2017.
  33. ^ Knights, Miya (4 December 2006). "Technology high on transport review agenda". Cio.co.uk. Retrieved 4 December 2017.
  34. ^ King, Leo (7 December 2009). "Chancellor threatens future of NHS IT programme". Cio.co.uk. Retrieved 4 December 2017.
  35. ^ "Intellect Blog » Christine Connelly". Archived from the original on 26 July 2011.
  36. ^ "NHS patient records project faces axe, says Cameron | Software | silicon.com". Archived from the original on 18 May 2011. Retrieved 13 May 2011.
  37. ^ "Government plans new 'regulatory levers' to force pace of NHS's digital uptake". Health Service Journal. 30 June 2022. Retrieved 26 August 2022.
  38. ^ "Government provides £25m for rapid digitisation of social care". Home Care Insight. 13 June 2022. Retrieved 26 August 2022.
  39. ^ "Civil service cuts put mental health strategy at risk - 2/2/2011 - Community Care". Archived from the original on 10 July 2011. Retrieved 12 September 2011.
  40. ^ Shuttleworth, Kelly; Nicholson, Elspeth (18 August 2020). "Devolution and the NHS". Institute for Government. Retrieved 13 June 2024.
  41. ^ "The Barnett Formula, House of Commons Library brief" (PDF). parliament.uk.
  42. ^ "Scotland Act 1998, Schedule 5, Part II". Opsi.gov.uk. Retrieved 9 May 2022.
  43. ^ "Northern Ireland Act 1998, Schedule 3". Opsi.gov.uk. 25 June 1998. Retrieved 4 December 2017.
  44. ^ TheyWorkForYou (13 July 2009). "House of Commons, Written answers and statements". Theyworkforyou.com. Retrieved 4 December 2017.
  45. ^ "Government of Wales Act 2006, Schedule 7A, Part II". legislation.gov.uk. Retrieved 29 April 2022.
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