How does the NHS in England work and how is it changing?

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  • Posted:Thursday 26 May 2022

What are the key organisations that make up the NHS? And how can they collaborate with partners in the health and care system to deliver joined-up care? Watch our animation to find out.

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Big changes are taking place across the health and care system.  

  • What does this mean for the organisations that make up the NHS?  
  • How will they collaborate with other parts of the system?  
  • And what’ll these changes mean for you and me?  

When the NHS was set up, it focused on treating single conditions or illnesses. 

Since then, our health and care needs have changed; more of us are living longer and many have multiple conditions that require regular, ongoing care.  

However, this hasn’t been reflected in the NHS’s structure, a patchwork of organisations that often work independently from one another. Navigating this can be confusing and can have a negative impact on our experience of care.  

So, for some years now, health and care staff and leaders, have been working to bring organisations closer together to better meet our needs by working in a joined-up way.  

Primary and secondary care, social care, mental health and community health services have been seeking to partner with each other in different ways.  
At a very local level, GP surgeries have been coming together to form primary care networks, groups of practices working together across areas called ‘neighbourhoods’. By sharing resources and working closely with other local people and services, they can provide a wider range of services than a single GP surgery.  

Health and care organisations have also been working together across larger areas called ‘places’ – often covering the same area as a local authority – where large parts of the NHS budget are spent. Here, local government, charities, residents and NHS partners can work together to understand and meet local health needs.  

But previous laws have prevented services becoming even more joined-up.  

The 2022 Health and Care Act aims to change this and make it easier for organisations to work together.  

But what do these changes look like?  

Organisations are now coming together across even larger areas to form integrated care systems, partnerships of health and care organisations that plan and pay for health and care services.  

There are around 40 integrated care systems across England and although they’ve existed for some time, the Health and Care Act gives them legal status, as well as new powers and responsibilities.  

Integrated care systems are made up of two parts: integrated care boards and integrated care partnerships.  

Integrated care boards decide how the NHS budget for their area is spent and develop a plan to improve people’s health, deliver higher-quality care and better value for money.  

Integrated care partnerships bring the NHS together with other key partners, like local authorities, to develop a strategy to enable the integrated care system to improve health and wellbeing in its area. 

NHS trusts are also coming together to form provider collaboratives, new partnerships that can bring together providers such as hospitals, mental health services and community services. 

So, how are these new structures funded? 

Integrated care systems get most of their money from NHS England, which is the national body for the NHS in England, and sets the operational priorities for the health system.  

It’s responsible for the health services you and I access day to day, which are inspected and regulated by the independent Care Quality Commission. 
The Department of Health and Social Care sets out what the NHS is expected to deliver for the money it gets from the government – which comes from our taxes. It also holds budgets for some of the other areas that have an impact on our wellbeing, like public health.   

Throughout these new structures, local authorities play a key role; they receive money locally and from national government, which goes towards funding a range of services that support our wellbeing and prevent ill health.  

So, what does this all mean in practice?  

The Health and Care Act has put in place a legal framework, that enables services to work more closely together, so it’s easier for you and I to receive the care we need, when and where we need it.  

For these changes to succeed, staff and local leaders will have to work with one another differently, alongside key partners in local government, the voluntary sector, and communities themselves. 

Of course, services face other challenges, like workforce shortages, growing waiting lists and the impact of the Covid-19 pandemic.  

While the new structures won’t fix all these issues, by enabling services to work more closely together and join up services for patients, it’s hoped that the health and care system will be better able to meet our changing health and care needs in the future.   

Find out more about how the health and care system is changing at 

Want to find out more?

Explore some of our resources that can help you make sense of the reformed health and care system: 

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This animation has been developed by The King’s Fund with the support of:

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Visit the CF website to find out more.

About the animation

The content for this animation was devised by The King’s Fund. Thank you to ARC for design and production and to Elexi Walker for the narration. 

This is an update of our 2017 animation on the structure of the NHS


David Atkinson

Retired Senior Education Officer. Now volunteer as Chair of PPG and Chair of South Patient Participation Group,
Former Northamptonshire County Council
Comment date
31 May 2022

I a.m fully supportive of plans for Integrated Care. For it to work effectively it is essential that all parts of the services take ownership of the proposals and commit to working together. For too long different branches of the Services have been protective of their own areas of work and expertise which has led to competition and not co-operation.
Patient involvement will also be key to the success of the proposals

Andy Yacoub

Healthwatch Suffolk CIC
Comment date
06 June 2022

Another very helpful short film by The King's Fund, thank you. If I would have changed anything about the content, it would be the following: (1) Integrated Care and its future (i.e. it impact) is an 'aspiration' rather than a 'given', which is only alluded to at the end of the film. (2) Social Care doesn't feature prominently enough (if at all). (3) The public voice, and that of the H&C workforce, is critical to the success of ICB/Ps - this could have been stronger. (4) Is there a BSL version of the film, and can the film be accessed with subtitles? Thank you.

Rubina Reza

Head of Research & Development,
Derbyshire Healthcare NHS Foundation Trust
Comment date
09 June 2022

Helpful animation - How does the NHS in England work and how is it changing? - explains a complex new structure, but can such change really be made because "'s hoped that the health and care system will be better able to meet our changing health and care needs in the future." Is there no evidence to suggest that it will do so?


Digital Content Producer,
The King's Fund
Comment date
23 June 2022

Dear Andy,

Thank you for getting in touch and for sharing your feedback regarding the animation.

We certainly recognise the hurdles that need to be overcome for the reforms to be successful and noted some of the key challenges in the animation eg, workforce pressures, the impact of Covid-19, the need for people to work in different ways. But we also wanted to show the opportunities that integration could bring. In our wider work we’ll be supporting the system to tackle these challenges and make the most of the reforms, and this is going to be one of our key aims as an organisation for the coming years.

Social care will of course need to be a core partner throughout these changes. We are currently working on a piece of work with providers of adult social care seeking to understand how their insights and experience can become better embedded in ICSs.

Public voice will be critical to the success of ICSs too. Due to the long lead time for the animation (over 9 months!), we unfortunately weren’t able to include some of the richer detail on how ICSs should work with people and communities that has been explored in recent guidance. We have a number of pieces of work underway which aim to support ICSs to make better use of insights from patients and the public, including our publication from last year: Understanding integration: how to listen to and learn from people and communities:…

Finally, on accessibility, subtitles are available on the animation. Users can turn these on and off by toggling the ‘cc’ button on the animation player window, depending on what they find most useful. We don’t currently have a BSL version of the animation available, but this is certainly something we can feedback into our project wash up and use to inform future work.

I hope the above is helpful. Thank you again for taking the time to share your feedback with us - it is all really valuable and can help inform future work in this space.

Best wishes,

David. J. Morris

Member of a Hospital Pt Experience Committee VE Member of the various Healthwatch type Organisations since I retired ") years ago,
Vice Chair of Local Over 50 Forum
Comment date
29 July 2022

When Government ceases to meddle with OUR Health care system and allows True and fair well publicised Public representation ,and Not Party Political games (Or Friends of a particular Party) You are now putting up another "Body" to reorganise the NHS. The main problem is constantly placing Social Care into the hands of Local Government. in Social services. This is a National responsibility and SS should rightly be part of and subject to NHS Departments. The Links Organisation which preceded H Watch . was in Kent doing a good job and shocked the local Health services into action. ( I suspect that is the reason LINKS was abolished . HW has been set up with much less power to force change and they appear to be afraid to use those powers that they do have, Local Government is populated with too many Wannabes who like to use Our funds to try out things they would like to carry out in business and bully Working People into submission.
It is time some of the layers of Local Government were abolished and as for the idea of an Elected Mayor with Executive Power ! Just look at the kind of Clown that foisted on to London then on to the whole country. U.K. is the laughing stock of The world . Our press does not have the guts to repeat the things being said all over the World about the U.K.

Hanif bobat

Health care advisor,
Self Employed
Comment date
07 September 2022

ICB, and all new structures are a waste of time and money!! It keeps a small number of people in jobs and retire with a nice pension!!
NHS is great at emergency care,, otherwise going the USA route.

Tawanda Beremauto

Comment date
28 November 2022

That is a very helpful video,an eye opener to how the system operates and intend to expand.

Priscilla Gennaro

Executing art/ creativity,
Comment date
20 June 2023

I have learned such a lot about the organisations that all come together with parents/ carers and assistants to make sure children under the autistic spectrum receive
and obtain their potential leading them into adulthood with confidence.

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