“We made three mistakes that I regret, the first being restructuring the NHS. The rest are minor.”— unnamed Senior Conservative Cabinet Minister
NHS structure explained
An interactive timeline from the Nuffield Trust shows changes to the NHS over the past 70 years, through pictures and links to more detailed accounts of events. (see http://nhstimeline.nuffieldtrust.org.uk/)
For a history of the NHS and its ‘re-disorganisation’, see http://www.sochealth.co.uk/national-health-service/reform-of-the-national-health-service/. This also has useful links to other sources of information, such as a review of the way health services have been restructured in the UK and elsewhere, suggesting that re-organisations are not usually based on evidence, and produce unclear, if not negative, effects. http://www.medicalnewstoday.com/releases/34840.php
The NHS is no longer a single body. It consists of
- strategic bodies, principally the Department of Health, NHS England and other agencies at arm’s length from the government, including
- Monitor (the economic regulator),
- the Care Quality Commission or CQC (regulating the quality of health and social care services)
- the Trust Development Agency (which performance manages NHS Trusts),
- the NHS Litigation Authority (which handles complains and improves risk management)
- Healthwatch England (which can recommend action is taken where this concern about NHS services and ensure views of the public are taken into account)
- Public Health England (which responds to health emergencies like epidemics and provides leadership for public health departments in based in local authorities),
- Health Education England (responsible for ensuring sufficient staff with the right skills and for quality education and training for the healthcare workforce)
- National Institute for Health and Care Excellence or NICE ( which develops evidence to inform best possible health and social care)
- Local commissioning bodies (211 Clinical Commissioning Groups or CCGs)
- NHS Trusts (reporting to the Trust Development Agency)
- FoundationTrusts (reporting to Monitor)
In addition, the boundaries of the NHS are affected by moves to
- outsource services to the private sector
- work in partnership with local authorities, notably in the provision of social care (see ‘integrated care‘)
One starting point for understanding the new structure of the NHS is an article on the BBC’s website, http://www.bbc.co.uk/news/health-19674838. This was posted before the HSC Act was implemented, so shows both the old structure and the new one brought in by the Act.
For a slightly different version, see http://datagoat.files.wordpress.com/2012/05/lucys-nhs-landscape-with-public-health-england-1-may-2012.pdf.
However, while both these sites are useful for comparing the old and new structures, they are out of date: for example, the first site makes no mention of Commissioning Support Units (CSUs), which are taking over much of the business of Clinical Commissioning Groups (CCGs). The National Commissioning Board that both sites refer to has been transformed to become NHS England; NHS Scotland; NHS Wales; and NHS Northern Ireland. Neither site gives any indication that the legal responsibility for providing a comprehensive health service has been removed from the Secretary of State for Health.
More useful perhaps is the King’s Fund’s website, which has a section called “NHS in a nutshell“. This has a range of information, for example about how the NHS is funded, how much the UK spends on health care compared to other countries, and so on. And it includes a useful animated video explaining how the NHS is structured, along with how it relates to public health bodies and local authorities. See http://www.kingsfund.org.uk/projects/nhs-in-a-nutshell.