The NHS is a huge ecosystem spanning over 1.5 million employees, and hundreds of organisations…which can be very confusing. This video addresses that knowledge gap – who’s who, what does everybody do, and where do you come in?
The British NHS is split into its four constituent nations (England, Wales, Northern Ireland, and Scotland), each with its own government taking responsibility for its own NHS.
The English NHS is the largest system.
The Government sets out the NHS mandate each tax year, detailing how much of taxpayers’ money will go towards the NHS that year and setting priorities (i.e. OBJECTIVE 3: To balance the NHS budget and increase productivity).
The Department of Health and Social Care, led by MP Matt Hancock (previously Jeremy Hunt), is the branch of government that develops policies and guidelines for health and social care delivery. The delivery of healthcare officers through external bodies:
1. Service delivery organisations
This is looking after patients, and overseen by NHS ENGLAND (led by CEO Simon Stevens). NHS England set strategies for care delivery in the NHS (i.e. Five Year Forward View), and oversee the commissioning of NHS services in the UK.
Commissioning of NHS services is done by CLINICAL COMMISSIONING GROUPS (CCGs). There are 195 in England, and they’re given about 2/3 of the NHS budget to buy services for hospitals and community care.
They buy this care from SERVICE PROVIDERS, organisations that compete and bid for contracts to provide patient care. These include organisations like NHS Trusts, GPs, charities, and private providers.
Most junior doctors will find themselves working for NHS FOUNDATION TRUSTS, which are part of the NHS and subject to NHS standards. A Foundation Trust is an independent legal entity and take no direction from the DoHSC. Foundation Trusts have locally appointed board members, and are allowed to fundraise however they wish, including provision of private services. There are 153 Foundation Trusts in England.
There are also non-foundation Trusts (NHS Trusts), who do take their direction from the DoHSC. There are plans for these to achieve foundation status within the next few years.
PUBLIC HEALTH ENGLAND is another agency, sponsored by the DoHSC. They provide health protection, epidemiology, and microbiology in England. Junior doctors who choose specialty training in Public Health may find themselves working with this agency at some point.
2. Monitoring and regulation organisations
This is done by two major organisations:
NHS IMPROVEMENT (led by CEO Ian Dalton) is a new organisation founded in 2016. They bring together smaller organisations (Monitor, Patient Safety). This organisation oversees the service delivery and spending by NHS Trusts and Foundation Trusts, and holds them to account. They also set the rules for spending by these Trusts (i.e. the locum cap).
The CARE QUALITY COMMISSION (CQC) inspects the quality of patient care (set by NICE). The CQC reports their findings to the government through the DoHSC.
3. Workforce training and development organisations
These organisations, which aren’t always part of the government, carry out government tasks and receive funding from the DoHSC to do so.
This is led by Health Education England (HEE, current CEO Prof Ian Cumming). HEE is a non-departmental public body, responsible for the provision and management of the NHS workforce. For junior doctors, this means HEE recruit, allocate, and provide funding for junior doctor training posts with NHS Trusts.
HEE is split into 4 regions, which are further divided into 13 Local Offices, which split up into specialty schools.
That was a lot – but stay tuned for our breakdown of HEE!