“In [the] future, the NHS will be a state insurance provider not a state deliverer.”— (Mark Britnell, former Head of Commissioning, Department of Health)
NHS structure explained
In 2010 a government white paper set out plans to reduce central control of the NHS, give doctors the job of planning and buying the majority of health services, and give patients greater choice.
These plans were implemented by the Health and Social Care Act 2012 (HSCA 2012), which brought in the biggest and most controversial restructuring of the NHS since it was set up in 1948.
The current structure is as follows:
The Department of Health, supported by 23 agencies and public bodies, is responsible for funding and strategic leadership for health and social care in England.
The Secretary of State for Health has responsibility for the work of the Department of Health. The HSCA 2012 removed the legal responsibility for providing a comprehensive health service from the Secretary of State for Health.
NHS England (previously the National Commissioning Board) is an independent body, at arm’s length to the government. It’s main role is to set the priorities and direction of the NHS in England and to improve health and care outcomes. It has been the commissioner for primary care services, such as GP care, but some of this work is now shared with Clinical Commissioning Groups (‘co-commissioning). NHS England has a duty to involve patients, carers and the public in decisions about the services they commission.
Monitor was responsible for monitoring NHS Foundation Trusts, ensuring patient choice and preventing ‘anti-competitive behaviour’. (It was later absorbed into NHS Improvement).
Clinical commissioning groups (CCGs) are clinically led, statutory NHS bodies responsible for the planning and commissioning of healthcare services for their local area. CCG members include GPs and other clinicians, such as nurses and also have lay representatives. They are responsible for about 60% of the NHS budget, they commission most secondary care services, such as planned hospital care; urgent and emergency care (including ‘out of hours’ and NHS 111); learning disability services, mental health services, and most community care services. They also share the commissioning of GP services with NHS England.
CCGs can commission any service provider that meets NHS standards and costs. These can be NHS hospitals, social enterprises, charities or private sector providers.
CCGs have a duty to involve their patients, carers and the public in decisions about the services they commission.
The HSCA 2012 also gave local authorities new public health responsibilities and introduced local Healthwatch organisations.
More recent, non-statutory, changes have included:
- The division of the NHS in England into 44 areas or footprints (now referred to as Sustainability and Transformation Partnerships) in which local health and care organisations together create plans to implement the NHS Five Year Forward View. These Partnerships are expected to evolve into Accountable Care Systems and, in time, some will become Accountable Care Organisations. In future it’s expected they will take on some of the work of CCGs.
- The incorporation of Monitor into NHS Improvement, along with the Trust Development Authority, Patient Safety and other organisations, with a new emphasis on supporting providers and local health systems to improve their services.
- The devolution of the £6 billion health and social care budget in Greater Manchester from April 2016.
For further, detailed information see
http://www.england.nhs.uk/wp-content/uploads/2014/02/dh-nhse-framewk-agreement.pdf (withdrawn but useful for history)
For the history of the NHS up to 2010, see