How we fit into the NHS structure
The Department of Health have created an interactive diagram which gives an overview of the health and care system that came into effect from April 2013. It illustrates the statutory bodies that will make up the system, oriented around people and communities and where they receive their local health and care services.
The sections below will give you a brief introduction to the various organisations and their roles.
The Secretary of State for Health has ultimate responsibility for the provision of a comprehensive health service in England and ensuring the whole system works together to respond to the priorities of communities and meet the needs of patients.
The Department of Health (DH) will be responsible for strategic leadership of both the health and social care systems, but will no longer be the headquarters of the NHS, nor will it directly manage any NHS organisations. For detailed information about the department’s new priorities and roles visit the DH website.
Formerly established as the NHS Commissioning Board in October 2012, NHS England is an independent body, at arm’s length to the government. It’s main role is to improve health outcomes for people in England. It will:
- provide national leadership for improving outcomes and driving up the quality of care
- oversee the operation of clinical commissioning groups
- allocate resources to clinical commissioning groups
- commission primary care and specialist services
For more information, visit NHS England.
Primary care trusts (PCTs) used to commission most NHS services and controled 80% of the NHS budget. On April 1 2013, PCTs were abolished and replaced with clinical commissioning groups (CCGs). CCGs have taken on many of the functions of PCTs and in addition some functions previously undertaken by the Department of Health.
All GP practices belong now to a CCG and the groups also include other health professionals, such as nurses. CCGs commission most services, including:
- planned hospital care
- rehabilitative care
- urgent and emergency care (including out-of-hours)
- most community health services
- mental health and learning disability services
CCGs can commission any service provider that meets NHS standards and costs. These can be NHS hospitals, social enterprises, charities, or private sector providers.
However, they must be assured of the quality of services they commission, taking into account both National Institute for Health and Care Excellence (NICE) guidelines and the Care Quality Commission’s (CQC) data about service providers.
Both NHS England and CCGs have a duty to involve their patients, carers and the public in decisions about the services they commission. Read more about what we are doing to involve you.
Every ‘upper tier’ local authority is establishing a health and wellbeing board to act as a forum for local commissioners across the NHS, social care, public health and other services. The boards are intended to:
- increase democratic input into strategic decisions about health and wellbeing services
- strengthen working relationships between health and social care
- encourage integrated commissioning of health and social care services
Also read the DH’s guide on Health and wellbeing boards.
A new organisation is also being created; Public Health England (PHE) will provide national leadership and expert services to support public health and will also work with local government and the NHS to respond to emergencies. PHE will:
- coordinate a natonal public health service and deliver some elements of this
- build an evidence base to support local public health services
- support the public to make healthier choices
- provide leadership to the public health delivery system
- support the development of the public health workforce
The CQC continues to regulate all health and adult social care services in England, including those provided by the NHS, local authorities, private companies and voluntary organisations.
Read more about the CQC.
Monitor expanded its role to regulate all providers of health and adult social care services. Monitor aims to promote competition, regulate prices and ensure the continuity of services for NHS foundation trusts.
Under the new system, most NHS providers will need to be registered with both the CQC and Monitor to be able to legally provide services.
Note: all service providers are required to hold a licence issued jointly by the CQC and Monitor. To get a licence, providers will need to meet essential standards of quality and safety. They’ll also have to follow certain behaviours relating to price setting, integrated care and competition. More importantly, providers will have to ensure services don’t stop in the event of financial difficulties. If a provider does not fulfil the terms and conditions of the licence, both Monitor and CQC can take independent action, such as issuing warning notices or financial penalties.
Find out more about NHS Improvement.
Healthwatch is a new organisation and functions as an independent consumer champion, gathering and representing the views of the public about health and social care services in England.
It operates both at a national and local level and ensures the views of the public and people who use services are taken into account.
Locally, Healthwatch will give patients and communities a voice in decisions that affect them, reporting their views, experiences and concerns to Healthwatch England. Healthwatch England will work as part of the CQC.
Read more about Healthwatch England.