How does the NHS work? A never-ending story

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‘Nobody knew that health care could be so complicated.’ So said Donald Trump earlier this year as he set out to overhaul Barack Obama’s signature health care policy, the Affordable Care Act.

It may have come as a surprise to the US President, but those working in health policy across the globe have long been aware of the complexities of providing health care for millions of people in a way that is efficient, safe and equitable.

In England, the array of different organisations that make up the health service and the way they do (or don't) work together can be baffling, even for those who work in the NHS. Once you’ve got your head around which organisation does what, you need to get to grips with the acronyms that pop up, mushroom-like, to describe the array of initiatives around new ways of working, new ways of containing spending and new ways of delivering care.

Back in 2013, when the health system was reeling from sweeping reforms set in motion by then-Health Secretary Andrew Lansley, the Fund made an attempt to try to explain this complexity. One of our leadership development consultants, Liz Saunders, had devised a popular session for clinicians in which, with the aid of flip-charts and a good dose of humour, she explained the health system created by the 2012 Health and Care Act. We boiled this session down into a six-and-a-half minute script, and then teamed up with a talented group of illustrators and animators to create an animation providing a whistle-stop tour of the NHS. It hit the spot – a frank and sometimes tongue-in-cheek explanation of what for many (most of us?) was a confusing raft of reforms.

Since then, the animation has been viewed more than 330,000 times, making it the Fund’s most viewed-ever piece of digital content. It is used in staff inductions and training sessions across the country, has been translated into other languages, and has even featured in a comedy show.

The widespread success of the animation contributed to a growing feeling at the Fund that, in addition to our role as researchers, analysts and leadership development consultants, we had an important role to play in increasing understanding of how the health and care system works and is changing. This aspect of our role is now enshrined in our strategic goals and we have produced a range of resources that are widely used and shared.

In fact, our 2013 animation is still watched around 2,500 times a month, despite the fact that it's now out of date, created in the days of the coalition government, when Monitor still checked provider balance sheets and before the term STP (sustainability and transformation partnership) had been invented. Its continued success is testament to just how much a simple(ish) explainer of the way the NHS works is needed.

So we’ve decided it’s time for an update and we are proud, excited (and maybe a little bit nervous) to launch a new animation: How does the NHS in England work? An alternative guide. It's a difficult second album: if anything things are even more complicated than before – layered on top of the (slightly re-jigged and in some cases re-named) organisations that make up the health system, there is the array of new models and ways of working that are being adopted as part of the NHS five year forward view. There’s a lot to get through, but we’ve packed it in to six-and-a-half minutes, again.

We hope we've struck the right balance, giving a frank overview of the NHS in 2017 and how it is changing, telling things as they are rather than toeing any party line. We hope you like it, share it and tell us what you think. We'd also like to hear your suggestions about further resources we might produce to help explain aspects of health and care policy and practice. After all, in a rare alignment of the views of the US President and experts the world over: health care is complicated.


Helen Cameron

Head of Public Affairs,
The Salvation Army
Comment date
27 October 2017

Thanks for this animation. We'll use it to help our frontline understand the system. What would also be very helpful is an animation or even leaflet that summarises how to influence service provision effectively given all this complexity. Where are the main points of influence and what do they respond to? It is much clearer how to work with councils to influence change with the people we serve.


Comment date
24 October 2017

I would like to see an article on how medicines, treatments and services are procured and paid for and how the transaction between pharmaceutical companies and the NHS works. How are decisions made on what medicines/services are provided and who is responsible for this?


Faculty Manager EMEA,
Comment date
20 October 2017
Very nice video with a good focus on changes over time, explaining the NHS also to those who are not involved in it. The challenge of aging populations is a pretty global one and it's going to be interesting to see how different health systems approach it differently.

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