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Health and Social Care Act 2012
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Health and Social Care Act 2012
United Kingdom
Long title
An Act to establish and make provision about a National Health Service Commissioning Board and clinical commissioning groups and to make other provision about the National Health Service in England; to make provision about public health in the United Kingdom; to make provision about regulating health and adult social care services; to make provision about public involvement in health and social care matters, scrutiny of health matters by local authorities and cooperation between local authorities and commissioners of health care services; to make provision about regulating health and social care workers; to establish and make provision about a National Institute for Health and Care Excellence; to establish and make provision about a Health and Social Care Information Centre and to make other provision about information relating to health or social care matters; to abolish certain public bodies involved in health or social care; to make other provision about health care; and for connected purposes.
Citation
7
Introduced by
Andrew Lansley
Secretary of State for Health
Territorial extent
Section 46, 56 (1) and (3), 57, 58, 60, 150 (2) and paragraph 1 of Schedule 13, Section 214 (1)
Section 222 (1), Sections 230(1) - (4), and (6) and paragraph 53 and 59 of Schedule 15, Part 7, Section 231 (1) , (3) And Part 2 of Schedule 20, Section 300, 301, Part 12, extend to England, Wales, Scotland and Northern Ireland, Sections 128-133 extend to England and Wales and Scotland only
Dates
Royal assent
27 March 2012
History of passage through Parliament
Text of statute as originally enacted
Revised text of statute as amended
The Health and Social Care Act 2012 (c 7) is an Act of the Parliament of the United Kingdom. It provides for the most extensive reorganisation of the structure of the National Health Service in England to date.[1] It removed responsibility for the health of citizens from the Secretary of State for Health, which the post had carried since the inception of the NHS in 1948. It abolished NHS primary care trusts (PCTs) and Strategic Health Authorities (SHAs) and transferred between £60 billion and £80 billion of "commissioning", or health care funds, from the abolished PCTs to several hundred "clinical commissioning groups", partly run by the general practitioners (GPs) in England but a major point of access for private service providers. A new executive agency of the Department of Health, Public Health England, was established under the Act on 1 April 2013.[2]
The proposals are primarily the result of policies of the then Secretary of State for Health, Andrew Lansley. Writing in the BMJ, Clive Peedell (co-chairman of the NHS Consultants Association and a consultant clinical oncologist) compared the policies with academic analyses of privatisation and found "evidence that privatisation is an inevitable consequence of many of the policies contained in the Health and Social Care Bill".[3] Lansley said that claims that the government is attempting to privatise the NHS are "ludicrous scaremongering".[4]
The proposals contained in the Act are some of the coalition government's most controversial. Although glanced at in the Conservative Party's manifesto in 2010,[5] they were not discussed during the general election campaign that year and were not contained in the Conservative – Liberal Democrat coalition agreement,[1] which mentioned the NHS only to commit the coalition to a real-term funding increase every year.[6] Within two months of the election a white paper was published, outlining what the Daily Telegraph called the "biggest revolution in the NHS since its foundation".[7] The bill was introduced in the House of Commons on 19 January 2011.[8][9] In April 2011 the government announced a "listening exercise", halting the Bill's legislative progress until after the May local elections. The "listening exercise" finished by the end of that month. The Bill received Royal Assent on 27 March 2012.
Contents
[hide]
1 Background
1.1 White Paper
1.2 "Listening exercise"
1.3 Amendments
2 Contents
2.1 Parts 1 and 2 Health service in England
2.2 Part 3 Regulation of health and adult social care services
2.3 Part 4 NHS foundation trusts & NHS trusts
2.4 Part 5 Public involvement and local government
2.5 Part 6 Primary care services
2.6 Part 7 Regulation of health and social care workers
2.7 Part 8, National Institute for Health and Care Excellence
2.8 Part 9, Health and adult social care services: information
2.9 Part 10, Abolition of public bodies
2.10 Parts 11 and 12, Miscellaneous
3 Public reactions
3.1 General
3.2 "Any qualified provider"
3.3 GPs as commissioners
3.4 Accountability
3.5 Pace and timing of change
3.6 Medical establishment reaction
3.7 Opposition groups
4 Effect of the Act
5 See also
6 References
7 External links
Background[edit]
The proposals in the Act were not discussed during the general election campaign in 2010 and were not contained in the Conservative – Liberal Democrat coalition agreement of 20 May 2010,[1] which declared an intention to "stop the top-down reorganisations of the NHS that have got in the way of patient care".[7] However, within two months a white paper outlined what the Daily Telegraph called the "biggest revolution in the NHS since its foundation".[7] The white paper, Equity and Excellence: Liberating the NHS,[10] was followed in December 2010 by an implementation plan in the form of Liberating the NHS: legislative framework and next steps.[11] McKinsey & Company who have been influential in the British Department of Health for many years was heavily involved in the discussions around the Bill.[12] The bill was introduced into the House of Commons on 19 January 2011[8] and received its second reading, a vote to approve the general principles of the Bill, by 321-235, a majority of 86, on 31 January 2011.[13]
White Paper[edit]
The Act had implications for the entire NHS. NHS primary care trusts (PCTs) and Strategic Health Authorities (SHAs) were abolished, with projected redundancy costs of £1 billion for around 21,000 staff.[14] £60 to £80 billion worth of commissioning will be transferred from PCTs to several hundred clinical commissioning groups, partly run by GPs. Around 3,600 facilities owned by PCTs and SHAs will transfer to NHS Property Services, a limited company owned by the Department of Health.
When the white paper was presented to Parliament the Secretary of State for Health, Andrew Lansley, told MPs of three key principles:
patients at the centre of the NHS
changing the emphasis of measurement to clinical outcomes
empowering health professionals, in particular GPs.
The white paper set out the following timetable. By April 2012 it proposed to:
establish the independent NHS Commissioning Board
establish new local authority health and well-being boards
develop Monitor as an economic regulator.
The Bill foresaw all NHS trusts becoming, or being amalgamated into, foundation trusts. The Bill also abolished the existing cap on trusts' income from non-NHS sources, which in most cases was previously set at a relatively low single-digit percentage.[citation needed]
Under the Bill's provisions the new commissioning system would be expected to be in place by April 2013, by which time SHAs and PCTs would be abolished.
The Bill was analysed by Stephen Cragg of Doughty Street Chambers, on behalf of the 38 Degrees campaign, who concluded that "Effectively, the duty to provide a national health service would be lost if the Bill becomes law, and would be replaced by a duty on an unknown number of commissioning consortia with only a duty to make or arrange provision for that section of the population for which it is responsible." It replaces a “duty to provide” with a “Duty to promote”.[15]
"Listening exercise"[edit]
After an increase in opposition pressure, including from both rank-and-file Liberal Democrats and the British Medical Association, the government announced a "listening exercise" with critics.[16] On 4 April 2011 the government announced a "pause" in the progress of the Bill to allow the government to 'listen, reflect and improve' the proposals.[17][18]
The Prime Minister, David Cameron, said "the status quo is not an option" and many within his and Nick Clegg's coalition said that certain aspects of the Bill, such as the formation of Clinical commissioning groups, were not only not open for discussion, but also already too far along the path to completion to be stopped.[19] Cameron insisted that the Act was part of his "Big Society" agenda and that it would not alter the fundamental principles of the NHS.
Part of the "listening exercise" saw the creation on 6 April 2011 of the "NHS Future Forum".[20] The Forum, according to Private Eye, "brings together 43 hand-picked individuals, many of whom are known as supporters of Lansley's approach".[21] At the same time, David Cameron set up a separate panel to advise him on the reforms; members of this panel include Lord Crisp (NHS chief executive 2000-2006), Bill Moyes (a former head of Monitor), and the head of global health systems at McKinsey,[21][22] as well as Mark Britnell, the head of health policy at KPMG. Six months previously Britnell had told a conference of private healthcare executives that "In future, the NHS will be a state insurance provider not a state deliverer," and emphasised the role of Lansley's reforms in making this possible: "The NHS will be shown no mercy and the best time to take advantage of this will be in the next couple of years."[23][24] KPMG issued a press statement on behalf of Britnell on 16 May 2011 stating
"The article in The Observer attributes quotes to me that do not properly reflect discussions held at a private conference last October. Nor was I given the opportunity to respond ahead of publication. I worked in the NHS for twenty years and now work alongside it. I have always been a passionate advocate of the NHS and believe that it has a great future. Like many other countries throughout the world, the pressure facing healthcare funding and provision are enormous. If the NHS is to change and modernise the public, private and voluntary sectors will all need to play their part."
However, the full report of the conference still remained online and unamended, three years later.[25] In June 2011 Cameron announced that the original deadline of 2013 would no longer be part of the reforms. There would also be changes to the Bill to make clear that the main duty of the health regulator, Monitor, will be to promote the interests of patients rather than promoting competition.[26]
The Future Forum report suggested that any organisation that treats NHS patients, including independent hospitals, should be forced to hold meetings in public and publish minutes. It also wants the establishment of a Citizens’ Panel to report on how easy it is to choose services, while patients would be given a right to challenge poor treatment. The original Bill sought to abolish two tiers of management and hand power to new bodies led by GPs, called commissioning consortia, to buy £60 billion a year in treatment. Professor Steve Field, a GP who chaired the forum, said many of the fears the public and medical profession had about the Health and Social Care Bill had been "justified" as it contained "insufficient safeguards" against private companies exploiting the NHS.[27]
Amendments[edit]
Following the completion of the listening exercise, the Bill was recommitted to a public bill committee on 21 June 2011.[28] On 7 September, the Bill passed the House of Commons and received its third reading by 316-251.[29] On 12 October 2011, the Bill was approved in principle at second reading in the House of Lords by 354-220.[30] An amendment moved by Lord Owen to commit the most controversial clauses of the Bill to a select committee was defeated by 330-262.[31] The Bill was subsequently committed to a committee of the whole House for detailed scrutiny. The committee stage was completed on 21 December 2011, and the Bill was passed by the Lords, with amendments, on 19 March 2012.[8] The Commons agreed to all Lords amendments to the Bill on 20 March 2012. The Bill received Royal Assent and became the Health and Social Care Act 2012 on 27 March 2012.[32]
Contents[edit]
Parts 1 and 2 Health service in England[edit]
Section 9 establishes the National Health Service Commissioning Board, which is now known as NHS England. The Secretary of State is to publish, annually, a document known as the mandate which specifies the objectives which the Board should seek to achieve. National Health Service (Mandate Requirements) Regulations are published each year to give legal force to the mandate.
Part 3 Regulation of health and adult social care services[edit]
Part 4 NHS foundation trusts & NHS trusts[edit]
Part 5 Public involvement and local government[edit]
Part 6 Primary care services[edit]
Part 7 Regulation of health and social care workers[edit]
Part 8, National Institute for Health and Care Excellence[edit]
Part 9, Health and adult social care services: information[edit]
Part 10, Abolition of public bodies[edit]
Sections 278 to 283 abolished the Alcohol Education and Research Council, the Appointments Commission, the National Information Governance Board for Health and Social Care, the National Patient Safety Agency, the NHS Institute for Innovation and Improvement and the Standing advisory committees.
Parts 11 and 12, Miscellaneous[edit]
Sections 284 to 309 contained various other provisions.
Public reactions[edit]
General[edit]
On 19 January 2012 two major unions of healthcare professionals that had previously tried to work with the Government on the bill, the Royal College of Nursing and the Royal College of Midwives, decided instead to join with the British Medical Association in "outright opposition" to the bill.[33] On 3 February 2012 the Royal College of General Practitioners also called on the Prime Minister to withdraw the bill.[34]
The Confederation of British Industry supported the bill, declaring that "Allowing the best provider to deliver healthcare services, whether they are a private company or a charity, will spur innovation and choice."[35]
In May 2011, a number of doctors from GP consortia wrote a letter to the Daily Telegraph in which they expressed their support for the bill, calling its plans "a natural conclusion of the GP commissioning role that began with fundholding in the 1990s and, more recently, of the previous government's agenda of GP polysystems and practice-based commissioning".[36] On 14 May 2011, The Guardian published an article reporting that the GP appointed to head the NHS "listening exercise" has unilaterally condemned the bill.[37] The article said that Steve Field had "dismissed" the plans "as unworkable" and that these statements were "provisional conclusions that could fatally undermine the plans". The Royal College of General Practitioners (RCGP) also denounced the bill.[38]
The Royal College of Physicians and Royal College of Surgeons[35] welcomed in principle the idea of medical professionals determining the direction of NHS services, but questioned the Bill's implementation of the principle, particularly in regard to the approach of making GP consortia the primary commissioning deciders, and also in regard to requiring competition. The British Medical Association said similarly.[35] Neither of these organisations supported the bill.
In February 2011 David Bennett, newly appointed Chair of Monitor, said the NHS could become like other privatised utilities, so that Monitor would potentially be a regulator like Ofcom, Ofgem and Ofwat: "We, in the UK, have done this in other sectors before. We did it in gas, we did it in power, we did it in telecoms […] We've done it in rail, we've done it in water, so there's actually 20 years of experience in taking monopolistic, monolithic markets and providers and exposing them to economic regulation."[39] The House of Commons Select Committee on Health condemned the comparison as not "accurate or helpful."[40]
"Any qualified provider"[edit]
Any Qualified Provider was called 'Any Willing Provider' under the Labour administration and was a mechanism deployed to improve patient choice. Physicians and other employees of the NHS were worried about the bill's intention to amend one of the founding pillars of the NHS to read "any willing provider" rather than the current language guaranteeing a needed service exclusively via the NHS and its direct affiliates and partners. Changing of the language of the NHS tenets to read "any willing provider" takes away that requirement and allows private sector providers to have a potentially major say inside the NHS, potentially introducing private-sector operations and pricing within the NHS and even opening up local NHS operations to the possibility of forced closure because the private industry could out-compete them and corral the NHS services into bankruptcy. The British Medical Association has said that "Forcing commissioners of care to tender contracts to any willing provider, including ... commercial companies, could destabilise local health economies and fragment care for patients. Adding price competition into the mix could also allow large commercial companies to enter the NHS market and chase the most profitable contracts, using their size to undercut on price, which could ultimately damage local services."[35]
See Any Qualified Provider.
GPs as commissioners[edit]
The bill intends to make general practitioners the direct overseers of NHS funds, rather than having those funds channelled through neighbourhood- and region-based Primary Care Trusts, as is currently done.[41]
There are concerns about fragmentation of the NHS and a loss of coordination and planning. The Royal College of General Practitioners said it was "concerned that some of the types of choice outlined in the government’s proposals run a risk of destabilising the NHS and causing long-term harm to patient outcomes, particularly in cases of children with disabilities, those with multiple comorbidities and the frail and elderly."[35] Similarly, the Royal College of Physicians said that "Whilst we welcome the broad provision in the bill to seek professional expertise, the RCP is concerned that the bill does not require that specialists are at the heart of the commissioning process."[35] The Royal College of Psychiatrists said it "would be dismayed if psychiatrists were not closely involved with local consortia of GPs in the development of mental health services."[35] The Royal College of Surgeons said that "the legislation leaves the question of regional level commissioning unanswered with no intermediary structure put in place."[35] And there are concerns about management expertise, particularly by looking at the US. The BMJ wrote that
"No matter how many GP consortiums eventually emerge, their number will probably greatly exceed the 152 primary care trusts they are replacing, which brings a set of new challenges. Smaller populations increase the chances that a few very expensive patients will blow a hole in budgets. More consortiums mean that commissioning skills, already in short supply nationally, will be spread even more thinly. Denied economies of scale, smaller consortiums may be tempted to cut corners on high quality infrastructure and management, thereby endangering their survival. These points emerge clearly from an examination of 20 years of US experience of handing the equivalent of commissioning budgets to groups of doctors. Some groups had severely underestimated the importance of high quality professional management support in their early days and gone bankrupt as a result."[1][42]
The House of Commons health committee has suggested the government let experts other than the consortia GPs and their direct allies get involved in the running of the consortia, including hospital doctors, public health chiefs, social care staff, and councillors. That idea has received some wider support and the government has agreed to give it consideration. Those close to Health Secretary Andrew Lansley have said, however, that Lansley is concerned adding too many people to consortia decision-making risks making the consortia too unwieldy."[43] In 2010 the same committee had gone so far as to declare that "if reliable figures for the costs of commissioning prove that it is uneconomic and if it does not begin to improve soon, after 20 years of costly failure, the purchaser/provider split may need to be abolished."[1][44]
Accountability[edit]
Kieran Walshe, professor of health policy and management and Chris Ham, chief executive of the King's Fund, have argued that "At a national level, it is difficult to see who, if anyone, will be in charge of the NHS. There will be five key national bodies: the Department of Health, the National Institute for Health and Clinical Excellence, the Care Quality Commission, the NHS Commissioning Board, and the economic regulator Monitor. Although the remit of each is set out in legislation, it is not clear how these national bodies will interact or how they will provide coordinated and consistent governance of the NHS."[45]
Clinical commissioning groups will operate as statutory bodies, though it has been suggested that up to third of CCGs are reluctant to do so.[46]
Pace and timing of change[edit]
The King's Fund said that "the very real risk that the speed and scale of the reforms could destabilise the NHS and undermine care must be actively managed."[35]
The BMJ said in January 2011 that "The bill promises that all general practices will be part of consortiums by April 2012, yet it took six years for 56% of general practices to become fundholders after the introduction of the internal market. Nearly seven years after the first NHS trust was granted foundation status, there are still more than half to go—within two years. And there’s more. The replacement for the 10 strategic health authorities—the NHS Commissioning Board—needs to be fully operational by next April. By then, GP consortiums should have developed relationships with local authorities, which will assume ultimate responsibility for public health via their new health and wellbeing boards, working alongside Public Health England, a completely new entity."[1] The BMA believes such targets to be either wholly impossible or, at best, able to be done only in a very roughshod manner, which could in turn have very serious on-the-ground consequences to NHS functioning.
Medical establishment reaction[edit]
The British Medical Association opposes the bill,[47] and held its first emergency meeting in 19 years,[48] which asked the government to withdraw the bill and reconsider the reforms, although a motion of no confidence in Andrew Lansley by the BMA failed.[48] A later motion of no confidence in Lansley by attendees at the Royal College of Nursing Conference in 2011, however, succeeded, with 96% voting in favour of the motion, and several speeches thereafter condemning Lansley threefold: the Health and Social Care Bill 2011 as-written; Lansley's decision not to address the entire Conference with a speech, but instead to hold a separate meeting with 40 Conference attendees in a separate space (taken as an insult to nurses, and leading to accusations of 'gutlessness'); and the current separate "efficiency savings" measures being undertaken across the NHS and those actions' material impact on frontline medical services, especially as contrasted with several prominent officials, including NHS leaders and Lansley himself, repeatedly assuring that NHS frontline services are 'protected' at all times regardless of these "savings" measures.[49][50] "People will die", Richard Horton, editor of The Lancet, warned in March 2012, as he predicted "unprecedented chaos" as a result of the reforms,[51] with a leaked draft risk-assessment claiming that emergencies could be less well managed and the increased use of the private sector could drive up costs.[52]
Opposition groups[edit]
A panorama of the 'Block the Bridge' anti-cuts protest on Westminster Bridge, in October 2011
Various pressure groups opposed the bill, including NHS Direct Action,[53] Keep Our NHS Public, 38 Degrees,[54] the Socialist Health Association, many Trades unions, including the Chartered Society of Physiotherapy, UNISON, and Unite.[55] 38 Degrees' petition against the reforms passed 250,000 signatures by 21 April 2011.[54] In March 2011 a motion at the Liberal Democrat spring conference called for changes to the Bill to ensure greater accountability and prevent cherry-picking by private providers, among other demands aimed at reducing marketisation of the NHS.[56] UNISON sponsored rapper NxtGen to create an unflattering hip hop track about the bill,[57] which has now been viewed over 390,000 times on YouTube.[58]
Jeremy Hunt was appointed Health Secretary in a cabinet reshuffle on 4 September 2012, succeeding Lansley.[59] He has previously co-authored a book calling for the NHS to be dismantled and replaced with a system of personal health accounts.[60] The deputy chairman of the British Medical Association, Dr Kailash Chand, said "Jeremy Hunt is new Health Secretary – disaster in the NHS carries on. I fear a more toxic right winger to follow the privatisation agenda."[61]
On 9 October 2011, a protest organised by UK Uncut took place on Westminster Bridge. an estimated 2,000 health workers and activists attended the protest.[62]
On 5 March 2012, the campaign group 38 Degrees erected 130 billboards in the centre of London with the aim of persuading David Cameron to abandon the bill.[63]
On 25 September 2013 Labour's shadow health secretary Andy Burnham promised that the party will repeal the Health and Social Care Act in "the first Queen's Speech" if elected.[64]
Effect of the Act[edit]
In January 2015 Chris Ham and others from the King's Fund produced a review of the government's health reforms. Their conclusions as far as the Act was concerned were that:
The reforms resulted in greater marketisation of the NHS but claims of mass privatisation are exaggerated
The reforms resulted in top-down reorganisation of the NHS which was distracting and damaging
New systems of governance and accountability are complex and confusing
The absence of system leadership is increasingly problematic when the NHS needs to undertake major service changes[65]
In November 2017 Jeremy Hunt in an interview with the Health Service Journal said "The idea of lots of competing foundation trusts and payment by results works well when you have in your mind that most of the work the NHS does will be single episode elective care, but when you’re dealing with complex patients who are going in and out of the system a lot those structures prove not to be fit for purpose."[66]
See also[edit]
Nicholson challenge
National Health Action Party
National Health Service Act 2006
National Health Service Act 1977 (c 49)
National Health Service and Community Care Act 1990 (c 19)
NHS Redress Act 2006
Health and wellbeing boards
References[edit]
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^ Jump up to: a b c www.parliament.uk, Bill stages — Health and Social Care Bill 2010-11
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Jump up ^ BBC, 6 April 2011, PM seeks to allay fears, but insists change is needed
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Jump up ^ Government to "pause, listen, reflect and improve" NHS reform plans guardian.co.uk, published 2011-04-06, accessed 2011-04-06
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^ Jump up to: a b Private Eye, Issue 1288, "Is anybody listening?", p30
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^ Jump up to: a b c d e f g h i BMJ (2011), Reaction: what they say about the health bill, BMJ 2011; 342:d413 doi:10.1136/bmj.d413
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Jump up ^ Campbell, Denis (13 May 2011). "NHS (Society),Health (Society),Society,UK news,Health policy,Andrew Lansley,Politics,GPs (Society)". The Guardian. London.
Jump up ^ "Health reform 'could destroy the NHS', doctors warn - politics.co.uk - Health". politics.co.uk.
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Jump up ^ House of Commons Select Committee on Health, 31 March 2011, Health Committee - Fifth Report. Commissioning: further issues
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Jump up ^ BBC, 5 April 2011, NHS changes: Points of contention, accessed 21 April 2011
Jump up ^ House of Commons Health Committee. Fourth report of session 2009-10. Commissioning.2010. www.publications.parliament.uk/pa/cm200910/cmselect/cmhealth/268/268i.pdf
Jump up ^ Kieran Walshe and Chris Ham (2011), Can the government’s proposals for NHS reform be made to work?, BMJ 2011; 342:d2038 doi:10.1136/bmj.d2038
Jump up ^ "Health Service Journal".
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^ Jump up to: a b Sky News, 15 March 2011, BMA Rejects Health Sec 'No Confidence' Vote
Jump up ^ BBC, 13 April 2011, Lansley sorry as nurses pass 'no confidence' vote
Jump up ^ BBC, 11 April 2011, NHS reform: Front-line clinical jobs 'under threat'
Jump up ^ Matt Chorley; Jane Merrick (25 March 2012). "NHS reforms 'will kill patients', warns editor of The Lancet". The Independent on Sunday. London. Retrieved 25 March 2012.
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^ Jump up to: a b 38 DegreesSave the NHS: Sign The Petition Archived 9 April 2011 at the Wayback Machine., accessed 21 April 2011
Jump up ^ Unite, Unite 4 our NHS
Jump up ^ guardian.co.uk, 13 March 2011, NHS reforms face overhaul after Liberal Democrats' rebellion
Jump up ^ Union paid for Andrew Lansley rap attack, Mirror.co.uk, 3 April 2011
Jump up ^ Andrew Lansley Rap, 31 May 2011
Jump up ^ "Cabinet reshuffle: Lansley replaced by Hunt in health job". BBC News. 4 September 2012.
Jump up ^ Toby Helm and Rajeev Syal (16 August 2009). "Key Tory MPs backed call to dismantle NHS". the Guardian. Retrieved 31 January 2014.
Jump up ^ Smith, Rebecca (4 September 2012). "Jeremy Hunt is controversial appointment as Health Secretary". The Daily Telegraph. London.
Jump up ^ Taylor, Matthew (9 October 2011). "Protesters against NHS reforms occupy Westminster Bridge". The Guardian. London.
Jump up ^ Mulholland, Hélène (28 February 2012). "Anti-NHS-reform billboards to target London mayoral elections". The Guardian. London.
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Jump up ^ "Exclusive: Internal market and FT 'islands' hamper safe care, says Hunt". Health Service Journal. 28 November 2017. Retrieved 2 January 2018.
External links[edit]
Bill as introduced in the House of Commons
Bill as introduced in the House of Lords (reflecting changes made after the Listening Exercise)
Bill progress page on parliament.uk
BMJ minisite focusing on reforms to the NHS
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Dæmon (His Dark Materials)
From Wikipedia, the free encyclopedia
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Leonardo da Vinci's Lady with an Ermine (1489–90), along with two portraits by Giovanni Battista Tiepolo and Hans Holbein the Younger, helped inspire Pullman's "dæmon" concept.[1]
A dæmon /ˈdiːmən/ is a type of fictional being in the Philip Pullman fantasy trilogy His Dark Materials. Dæmons are the external physical manifestation of a person's 'inner-self' that takes the form of an animal. Dæmons have human intelligence, are capable of human speech—regardless of the form they take—and usually behave as though they are independent of their humans. Pre-pubescent children's dæmons can change form voluntarily, almost instantaneously, to become any creature, real or imaginary. During their adolescence a person's dæmon undergoes "settling", an event in which that person's dæmon permanently and involuntarily assumes the form of the animal which the person most resembles in character. Dæmons are usually of the opposite sex to their human, though same-sex dæmons do exist.
Although dæmons mimic the appearance and behaviour of the animals they resemble perfectly, dæmons are not true animals, and humans, other dæmons, and true animals are able to distinguish them on sight. The faculty or quality that makes this possible is not explained in the books, but it is demonstrated extensively, and is reliable enough to allow humans to distinguish a bird-shaped dæmon within a flock of birds in flight.
Dæmons frequently interact with each other in ways that mirror the behaviour of their humans, such as fighting one another when their humans are fighting, or nuzzling one another when their humans embrace, and such contact between dæmons is unremarkable.
Contents
1 Form
2 Separation
2.1 Intercision
3 Lifespan
4 In other languages
5 Dæmons in other literature
6 See also
7 External links
8 References and notes
Form[edit]
In Lyra's world, every human or witch has a dæmon which manifests itself as an animal.[2] It is separate from and outside its human, despite being an integral part of that person (i.e. they are one entity in two bodies).
Humans in every universe are said to have dæmons, although in some universes they are invisible. In our universe, the books suggest, dæmons are integrated within the person. They have a naturally occurring external physical manifestation in Lyra's universe and some others. Dæmons that are already physical, such as Lyra's dæmon Pantalaimon, remain external even when they visit universes with normally-internal dæmons, such as our own. Typically dæmons and their humans are conscious or sleep at the same time. However, the dæmons of witches and shamans—as revealed in The Amber Spyglass—can remain awake while their humans sleep, and it is implied in Northern Lights that cedarwood can have a soporific effect on dæmons that allows them to sleep even if their humans are awake.
"The worst breach of etiquette imaginable" is for a human to touch another person's dæmon; even in battle, most soldiers would never touch an enemy's dæmon, though there are exceptions (such as between lovers or in particularly violent fights). The physical handling of a dæmon causes vulnerability and weakness in the person whose dæmon is being touched; Lyra feels violated when doctors manhandle her dæmon into a machine intended to separate them, and later experiences a flush when Pantalaimon licks Will Parry's injuries while in an Irish wolfhound form to comfort him due to Will lacking a dæmon of his own. However, dæmons can touch other dæmons freely; interactions between dæmons usually accentuate and illuminate the relationships between the characters, and can also be used as a means of passing information between humans without being overheard. The sexual element of human/dæmon interaction is also reflected when Pantalaimon and Kirjava assume their final forms, as they officially settle after Will and Lyra stroke the other's dæmon.
A child's dæmon has no fixed form, and may suddenly change into another animal's shape according to whim and circumstance. This shape-shifting ability, and the fact that a dæmon disappears instantly upon its human's death, implies that dæmons are not completely corporeal. However, their bodies are solid, and they can interact fully with people and objects in the material world. In Northern Lights and The Amber Spyglass, it is noted that Pantalaimon has a heartbeat of his own.
As children develop their mature personalities during puberty, their dæmons "settle" into a form which reflects the person's personality. For example, a human with a dog dæmon may tend to follow authority; in Northern Lights it is noted that most servants have dog dæmons (although a maid was noted with a hen dæmon), and all witches' dæmons take the form of a bird of some kind. In La Belle Sauvage Malcolm and Alice meet a woman they think of as a fairy who has a flock of butterflies rather than a single dæmon. There is no mention that some extraordinary change in personality might cause a dæmon's form to later change. At the beginning of the trilogy, Lord Asriel claims that the act of settling triggers Dust to begin to be attracted to the person.
A person's dæmon is usually of the opposite sex to its human; however, very occasionally, it may be the same sex as the person. Pullman has admitted that the reason for this is unknown even to himself, and has agreed that it may also indicate some other gift or quality, such as second sight, or that the person is homosexual, adding "There are plenty of things about my worlds I don’t know, and that’s one of them".[3] The single reference to such individuals is in Northern Lights, where their rarity is established.
Mary Malone is taught that, with practice, it is possible to see non-physical manifestations of dæmons in her universe of people who do not even know that they have them. The suggestion is that we all have dæmons, but we have not learned to recognize and display them.
It is revealed in La Belle Sauvage that infant dæmons learn to communicate with their humans. Pantalaimon initially 'talks' to Lyra in a style of pidgin English that the nuns caring for Lyra say both will grow out of. It is also confirmed that dæmons can be permanently injured, at least after settling; the hyena dæmon of Gerard Bonneville is struck in the leg during a fight (albeit with a stick, thus not violating the taboo) and is later shown with an amputated leg (it is unclear if this weakness applies to a dæmon that has not 'settled').
Separation[edit]
Hans Holbein the Younger's Lady with a Squirrel (1526-8)
Normally, a person and their dæmon must stay within a few yards of each other; Lyra Belacqua shows significant discomfort when her dæmon flies up to the second story window of a tower while she is standing outside the building. Another character expresses surprise when a shaman's dæmon is able to travel over forty feet from him without discomfort. Such separation from one's dæmon—sometimes called "pulling"—causes extreme pain and distress for both human and dæmon, and, given enough distance, results in death.
The most detailed account in the books shows pulling to be torturous both physically—like "an iron hand pulling ones heart out between ones ribs" —and emotionally. To Will- who was also enduring the pain of his dæmon being separated from him for the first time- it felt as bad as if he had, within his mother's earshot, asked for someone who was about to kill him "instead to kill his mother because he didn't love her".[4] A permanent separation between human and dæmon kills both and releases a huge burst of energy, which, for instance, is harnessed by Lord Asriel to blast a hole between two overlapping universes at the end of Northern Lights. The General Oblation Board initially accomplished this separation through simply tearing child and dæmon apart, but this generally resulted in the subject dying of shock.
It is revealed in The Amber Spyglass that certain trained people, particularly witches and human shamans, have achieved the ability to survive separation from their dæmons by undergoing an initial voluntary separation that must be done at a special location. For the witches this is at a canyon underneath the earth in Lyra's world.[5] Shamans endure grueling ordeals that involve leaving their dæmon as they embark on a spiritual quest, crossing an area of death where nothing may grow or live. After rejoining their dæmon they gain the ability to separate from them to a far greater extent than previously. Both witches and shamans regain their intimate bond with their dæmon, the only change is in the distance they can travel from each other. Lyra and Will achieve the ability to be distant from their dæmons by going through the World of the Dead. It is implied that their allies, the Gallivespians, endured a similar experience, but the Gallivespians died before they could meet their dæmons.
Some humans, for example, Mrs Coulter, are shown to have the ability to go farther from their dæmons than most others. Mrs Coulter's dæmon, a golden monkey, goes into Lyra's room when she is staying with Mrs Coulter to find her alethiometer (truth reader) despite not having undergone intercision, with Mrs Coulter talking to Lyra perfectly normally at the same time. The reasons Mrs Coulter can do this are not stated.
In La Belle Sauvage, Malcolm is able to leave his dæmon Asta hidden under a boat to guard the infant Lyra while he heads further inland to help Alice against Gerard Bonneville, but the effort leaves him gradually weakened the further away he is. Despite this, Malcolm is able to knock Bonneville down and save Alice before returning to Asta. The two are in pain after their reunion but not harmed.
Intercision[edit]
In the trilogy, a special guillotine made of manganese-titanium alloy is used by the General Oblation Board to separate people from their dæmon without killing them (known as intercision). However, unlike the prolonged separation known as a skill among witches and shamans, the guillotine permanently severs the bond between person and dæmon, and drastically reduces the person's creativity, intelligence, and psychological will: the adults who have successfully gone through the process seem blank and lifeless, and their dæmons subdued and incurious. The General Oblation Board continually perfects the process through experimentation, but Lyra encounters a young boy who cannot bear the results of his intercision; he physically and mentally deteriorates until he eventually dies. When Lyra finds dæmons that have been separated from their humans, the creatures are insubstantial and needy: they cluster desperately, held back only by the contact taboo.
Lifespan[edit]
It is uncertain when or how, or into what form, a dæmon is "born", but a baby's dæmon takes the form of a baby animal[6]. When a person dies, their dæmon fades away like "atoms of smoke." Likewise, when a dæmon is killed, its human dies as well.[7] How a dæmon acquires a name is not explained in the books, but clarified by Philip Pullman[8] as being normally given by the parents' dæmons. As Will Parry came from our world, his dæmon was not given a name in this way and was named Kirjava (meaning mottled in Finnish) by Serafina Pekkala when she first met the dæmon.
In other languages[edit]
In the Norwegian, Danish, Serbian, Italian, Swedish and Finnish editions of His Dark Materials the word "dæmon" is changed to "daimon". In Polish it is "dajmon". In Icelandic, the name "fylgja" (lit. follower) is used, in reference to the familiar spirits of folk lores. In the Spanish edition, "daimonion" is used. The Portuguese translation renders the word as "gênio" in reference to the familiar spirits in Greco-Roman mythology, although Brazilian new versions use "dimon" (older editions used "dæmon"). The Hungarian edition uses "daimón". In the Hebrew edition, the term is translated phonetically, apart from the mock-bible excerpts quoted in chapter 21 of Northern Lights; there, the word used for dæmon is "er'el", meaning angel, resembling the biblical Hebrew word for foreign gods – "elil" (lit. small deity). This reminisces the Greek Septuagint translation of the Old Testament, in which the word "elil" was made "daimon".
The use of the æ ligature (a and e rendered together as one letter) is old-fashioned English usage, sometimes still seen in words such as "mediæval" and "archæology", and is still used in Scandinavian languages. The Latin word for demon is daemon, while the Danish is "Dæmon".
Dæmons in other literature[edit]
Dæmon as a manifestation of a person's soul was described by American sci-fi writer C. L. Moore in a short story "Dæmon" (1946). Moore's dæmons were human-shaped creatures of various colours, following their master wherever he or she goes. They were invisible to ordinary people, but the protagonist, a boy with an intellectual disability, named Luis O'Bobo, was able to see other people's dæmons. Irish poet W. B. Yeats saw poetic inspiration as being the result of a conflict between the poet and his 'Daemon' (which he considered the disembodied spirits of the dead) in works of occult speculation such as his 1925 work A Vision. In the 2010 novel Zoo City by Lauren Beukes, certain characters are physically and metaphysically linked to animals in a similar way to Pullman's daemons.
See also[edit]
Concepts similar to that of the dæmon can be found in the belief systems of several cultures, such as Fylgja from Norse mythology, Naguals and Tonals from Aztec mythology, aku-aku from Easter Island, and familiar spirits from early modern English witchcraft. Elsewhere, a parallel can be seen in the Jungian concept of the anima and animus. However, the most famous dæmon holder was Socrates, who claimed that he could see and talk to his.
Book pages
Races and creatures in His Dark Materials
List of His Dark Materials characters
Locations in His Dark Materials
His Dark Materials
Northern Lights
The Subtle Knife
The Amber Spyglass
Lyra's Oxford
Similar concepts
Aku-aku
Anima and animus
Daemon (classical mythology)
Digimon
Familiar spirit
Fylgja
Nagual
Tonal (mythology)
Novels portal
General
Agathodaemon
Totem
Demon/Daemon (disambiguation)
External links[edit]
Philip Pullman Author's website
HisDarkMaterials.com Publisher Random House's His Dark Materials website
Scholastic: His Dark Materials UK publisher's website
Randomhouse: His Dark Materials U.S. publisher's website
BBC Radio 4's His Dark Materials site inc. Dictionary of His Dark Materials and web Q&A with Philip Pullman
The then Archbishop of Canterbury and Philip Pullman in conversation at the National Theatre, from The Daily Telegraph
BridgetotheStars.net Fansite for His Dark Materials and Philip Pullman
HisDarkMaterials.org His Dark Materials fansite
Cittagazze.com French His Dark Materials fansite
References and notes[edit]
Jump up ^ Robert Butler (2007-12-03). "An Interview with Philip Pullman". Intelligent Life. Archived from the original on 2008-03-05. Retrieved 2008-03-05.
Jump up ^ early editions of Northern Lights mention that a deceased scholar's dæmon had the form of a "young woman". However, this was removed in later editions
Jump up ^ Interview at Lexicon 2000
Jump up ^ The Amber Spyglass, Chap. 21
Jump up ^ Pullman, Philip (2007) [2000]. The Amber Spyglass. His Dark Materials. New York: Random House, Inc. p. 423. ISBN 978-0-440-23815-7. There's a region of our north land, a desolate, abominable place... No dæmons can enter it. To become a witch, a girl must cross it alone and leave her dæmon behind. You know the suffering they must undergo. But having done it... [their dæmon] can roam free, and go to far places.
Jump up ^ Pullman, Phillip. La Belle Sauvage: The Book of Dust Book One "[Six-month-old Lyra's] dæmon, the chick of a small bird like a swallow, was asleep"
Jump up ^ Pullman, Philip. The Golden Compass: His Dark Materials Book One. New York: Yearling, 2001. 291. Print. "A wolf dæmon leaped at [Iorek Byrnison]: he slashed at her in midair, and bright fire spilled out of her as she fell to the snow, where she hissed and howled before vanishing. Her human died at once."
Jump up ^ IRC interview of Philip Pullman by the BBC
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Long drive
From Wikipedia, the free encyclopedia
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A military veteran long drive competition
Long drive is a competitive sport where success is derived by hitting a golf ball the farthest by driving. A small but dedicated talent base of golfers populate the world of Long-Drive, with the top talent competing professionally in various events and exhibitions.
Contents
[hide]
1 Distance
2 Equipment
3 Notable long drivers
4 References
5 External links
Distance[edit]
Professional long drivers can average over 350 yards (320 m) in competition,[1] compared with 300 yard (274 m) averages from the top PGA Tour drivers[2] and 220 yards (201 m) for an average amateur.[3] Some shots in competitions surpass 400 yards (366 m).[4] The world record recognized by Guinness Records as the longest drive in a competition is 516 yards (472 m) by 64-year-old Mike Austin in 1974 at the US Senior National Open Qualifier with a 43.5" steel shafted persimmon wood driver.[5] The record distance achieved in The RE/MAX European Long Drive Championship is 473 yards (433m) by Allen Doyle in September 2005.[6] The record distance achieved in The RE/MAX South African Long Drive Championship is 506 yards (462.9m) by Nico Grobbelaar in September 2012. Fast swingers can swing their club heads at over 150 mph (245 km/h), well beyond the 85 mph (140 km/h) average for an amateur. They train for strength, flexibility, and speed and often perform corporate exhibitions for money, exhibiting a variety of trick shots. Ball speeds are nearly double that of an average golfer (220 mph).
There are several well-known names in long drive. Jason Zuback is perhaps the most famous, being one of three people to win multiple RE/MAX World Long Drive Championships, with four consecutive wins from 1996–99 and a win in 2006. Sean "The Beast" Fister is another, winning in 1995, 2001, and 2005. Jamie Sadlowski had back to back wins in 2008–09. The Golf Channel is currently the owner of the Long Drivers of America organization.
Equipment[edit]
Long drive clubs, which are always drivers, are different in many ways from consumer clubs. Until the recent club length limitation rules, the shafts were much longer than a normal 45 in (114.3 cm) shaft, sometimes exceeding 55 in (139.7 cm). In 2005, 50 in (127.0 cm) limitation was introduced (measured vertically).
In November, 2016, the World Long Drive Association (WLDA) announced a rule change as it relates to club length that went into effect immediately for all WLDA sanctioned events. The new rule states that all clubs used in competition must conform with the USGA® Rules of Golf (Appendix II, 1c), which limits club length to a maximum of 48 in (120 cm). The rule is upheld by the WLDA at all sanctioned events through the use of a CLUBLENGTH™ Ruler Measuring Tool that conforms to the USGA® method for measuring club length.
The rule change reduces the previous maximum length allowed by the WLDA, and is being implemented to allow Long Drive competitors to be held to the same standard of competition as Tour professionals in accordance with the USGA.[7]
Long drive shafts differ from standard shafts. The main difference is stiffness, as a shaft not stiff enough will lag in an inconsistent manner, causing a loss of control. These shafts are stiffer in flex and almost always made of graphite, which is lighter than steel. In order to be stiff, a shaft is usually heavier and stronger. The kick point or bend point is also higher for a lower trajectory relative to the swing, and the shaft has a lower torque, meaning that it will not twist as much, allowing the clubhead to stay straighter.
Clubheads usually approach the 460 cubic centimeter limit, rarely below 400 cc. They must stay within the Coefficient Of Restitution (COR) limit of 0.83, which measures how a ball hits off the surface. Most clubheads only approach the COR in the center of the club, so technology has allowed more area of the club to possess a COR of above 0.80. Thus, mishits are less affected by the newer clubheads. The loft of a long drive club is also much lower than a consumer club, sometimes around 4 or 5 degrees, as opposed to 10.5 degrees for an amateur's driver. The reason for lower lofted driver heads is to greatly reduce back spin. Too much back spin causes the ball to balloon or climb, creating a steep landing angle which does not allow the ball roll out. A flatter landing angle is desired to get the most out of the ball's forward velocity and energy.
Many competitions require golfers to use a specification ball for the tournament. The specific design characteristics of this ball include a dimple design that helps to maintain lower spin rates and a ball compression[definition needed] of 110. The average ball compression in golf varies from the mid-70s to the upper 80s.
Notable long drivers[edit]
David Mobley, World Long Drive Champion – 2004 – Ranked #1 in the World by Long Drivers of America in 2003, 2004, and 2005[8]
Bubba Watson, 424 yd. drive [9] (lost Long Drive contest to Jamie Sadlowski)
Alan Shepard, "Miles and miles and miles." Apollo 14, February 5, 1971.[10] (This occurred on the Moon with a 6-iron and is unofficial.)
Mike Austin, He was credited by Guinness World Records with hitting the longest drive in tournament play (471m/515 yards) in 1974
Sean Fister ("The Beast"), World Long Drive Champion 1995, 2001, 2005.[11][12]
Monte Scheinblum, 1992 U.S. National and World Long Drive Champion.[13]
Jason Zuback ("Golfzilla"), World Long Drive Champion 1996, 1997, 1998, 1999, 2006.Seniors World Long Drive Champion 2015.
Sandra Carlborg, Ladies Division WR holder 391,Yards World Long Drive Champion 2011,2012,2014,2015, 2017[14][15]
Phillis Meti 2006 & 2016 Womens World Long Drive Champion. WR for women's longest drive 406 yards [16] and being the youngest female World Champion 19 years, 2 months. Hit 349 yards on the WLD grid in 2008.,,[17][18][19][20]
References[edit]
Jump up ^ Re/Max World Long Drive Championships 2011, Rounds 8-13 Long Drivers of America, Retrieved 13 July 2012
Jump up ^ "PGA Tour Driving Distance". PGA Tour. Retrieved 15 January 2014.
Jump up ^ How far do average golfers really hit it? New distance data will surprise you Golf Digest
Jump up ^ Re/Max World Long Drive Championships 2011, Finals Long Drivers of America, Retrieved 13 July 2012
Jump up ^ Hudson, Alex (10 December 2010) Why has the longest golf drive record not been broken? BBC Click, Retrieved 8 December 2011
Jump up ^ Grobbelaar, Nico - Records Smashed! (3 September 2012)
Jump up ^ "World Long Drive Association Announces Rule Change - World Long Drive". 18 November 2016. Retrieved 6 June 2017.
Jump up ^ "The Longest Golfers on Earth" (PDF). www.longdrivers.com. 2014. Retrieved 30 January 2015.
Jump up ^ "Bubba Watson smashes a drive 424 yards at Bridgestone Invitational". PGA.com. Retrieved 6 June 2017.
Jump up ^ "Apollo 14: Facts About the 'Rookie' Crew & the Golf Ball". Space.com. 2012. Retrieved 19 November 2015.
Jump up ^ Sens, Josh (January 17, 2007). "The Boom Boom Drivers of America". Golf Magazine. Retrieved February 9, 2011.
Jump up ^ "Fister, Shinnick win world long drive championship titles". ESPN. Associated Press. October 26, 2005. Retrieved February 9, 2011.
Jump up ^ "Monte Scheinblum Shines When He's Hitting Off the Tee", Bucky Albers, Dayton Daily News, May 19, 1993, Retrieved December 23, 2010.
Jump up ^ "Zuback back on top of Long Drive world". ESPN. October 30, 2006. Retrieved February 9, 2011.
Jump up ^ Wuebben, Joe (May 2008). "Driving force; Jason Zuback is the biggest hitter golf has ever seen. He also answers to one of sport's most fitting nicknames: Golfzilla". Muscle & Fitness. Retrieved February 10, 2011.
Jump up ^ http://www.worldlongdrive.com/video/
Jump up ^ https://www.longdrivers.com/news/remax-world-long-drive-championship-results-1995-date-0
Jump up ^ "Q: How far can a woman hit a golf ball? (A: Farther than you.)". TravelGolf.com. Retrieved 6 June 2017.
Jump up ^ https://buildlongdrive.com/wp-content/uploads/2015/12/Long-Drive-Past-Champions-Archive_Nov-2015-UpdateV2.pdf
Jump up ^ "SMT Golf puts record-setting DB Plus driver in hands of regular golfers". vivians-blogs.blogspot.co.nz. Retrieved 6 June 2017.
External links[edit]
Long Drivers of America
Euro Longdrivers
Results for 2005 RE/MAX World Long Drive Championships
Results for 2006 RE/MAX World Long Drive Championships
Long Drivers of Holland
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