An alternative guide to the new NHS in England

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Comments: 88

In recent years, our health system has undergone profound change, with the 2012 Health and Social Care Act introducing the most wide-ranging reforms since the NHS was founded in 1948.

Watch and listen to our animation, which gives a whistle-stop tour of where the NHS is now – how the new organisations work and fit together – and explains that our new system is as much a product of politics and circumstance as design.

Watch the animation

Download the final image from the animation, showing the structure of the new NHS

Download a text transcript of the alternative guide to the NHS video

We recommend watching the animation in full screen. You can also view the animation with closed captions on our YouTube channel.

Updates as of April 2016

This animation was created in June 2013. Since then, there have been some changes to the way the system works:


The budget for the NHS in England in 2016/17 is £120.4 billion.

Nationally, NHS England commissions specialised services, primary care, offender healthcare and some services for the armed forces.

In April 2015, NHS England’s 13 local area teams were integrated into the four existing regional teams: London, Midlands and East, North and South, each maintaining a local presence.

In 2016/17, NHS England will transfer £71.9 billion to 209 clinical commissioning groups, responsible for commissioning a range of routine services (eg, urgent and emergency care services, elective hospital care, community health services, maternity and mental health services) for their local populations.

While NHS England initially commissioned general practice, CCGs are increasingly taking on responsibility for commissioning general practice in their area. In 2016/17 a total of 115 CCGs will have assumed full responsibility for the commissioning of primary medical care services under delegated commissioning arrangements. A further third will hold the responsibilities jointly with NHS England. Nearly all CCGs are expected to have taken on delegated arrangements by 2017/18.

Work is also ongoing to change the way in which specialised services are commissioned, including more collaborative commissioning between CCGs and NHS England.

Some CCGs are supported in their work by six (down from 19 when CCGs formally launched in April 2013) commissioning support units (CSUs) – although some also commission support from independent sector providers. Clinical senates and strategic clinical networks also provide expert clinical advice on issues that go beyond the remit of an individual CCG. There are also fifteen Academic Health Sciences Networks, intended to promote and encourage the adoption of innovation in health services. The remit of AHSNs is being considered as part of the Accelerated Access Review.

Local government

In 2016/17, there will be a mandatory minimum of £3.9 billion of pooled NHS funding to be spent jointly with local authorities as part of the Better Care Fund’s integration programme. Areas also have the flexibility to pool more than the mandatory amount.

From 1 October 2015 the responsibility for commissioning public health services for children aged 0-5 transferred from NHS England to local authorities. This marked the final part of the overall public health transfer which saw some wider public health functions (eg, services aimed at reducing drug and alcohol misuse) transfer to local government on 1 April 2013.


From 1 April 2016, leaders in Greater Manchester will start to have greater control over the region’s health and social care budget. This includes taking on delegated responsibility for several commissioning budgets currently controlled by NHS England, including for a number of specialised services and some public health services. These services will continue to be commissioned by NHS England, but decisions about service changes, finances, and quality and performance will be made through the newly appointed Chief Officer of Greater Manchester Health and Social Care, working with the 37 NHS organisations and local authorities in the region. Other areas are also pursuing ‘devolved’ arrangements.


From 1 April 2016, Monitor and the NHS Trust Development Authority will be brought together under a new umbrella organisation, NHS Improvement. The new body in charge of improvement in the NHS will also incorporate groups from three other organisations: NHS England’s Patient Safety Team and NHS Improving Quality’s Advancing Change Team; NHS Interim Management and Support’s two Intensive Support Teams; and the National Reporting and Learning System. NHS Improvement will oversee foundation trusts, NHS trusts and independent providers.

New models of care

The NHS five year forward view was published in October 2014, describing a range of changes, including new models of service delivery such as:

  • primary and acute care systems, to join up GP, hospital, community and mental health services
  • multi-specialty community service providers, to move specialist care out of hospitals into the community
  • enhanced health in care homes, to offer older people better, joined up health, care and rehabilitation services.

Since then, two further models have been introduced:

  • urgent and emergency care vanguards, to improve the coordination of services and reduce pressure on A&E departments, and
  • acute care collaborations, to link local hospitals together to improve their clinical and financial viability.

To implement these new care models, the NHS invited individual organisations and partnerships to apply to become ‘vanguards’ for the new care models programme; 50 vanguards have now been established across the country.

Share the new NHS animation

We hope you like the animation, let us know what you think and spread the word on Twitter or Facebook with the following link:

More about this animation

The inspiration for the animation was a session delivered to groups of clinicians as part of our leadership development programmes. Clinicians told us how useful the session was whilst being experts in their own part of the health system, they were less clear about how the whole, complex system fits together. Our animation aims to bring the essence of this session to a wider audience an introduction to the new NHS in 6.5 minutes. Find out more about our leadership development work.

Further resources on the new NHS


#40565 Lee Bailey
NHS Contractor (PCT/CSU)

Wonderful animation. I had worked in the NHS for 11 years, and subsequently left during all the ongoing transition. I have to say your animation 'An alternative guide to the new NHS in England', certainly captures the complexity of the new health system. Yet presented in a simple and informative. Thank you.

#40566 Jane King

What a brilliant animation. By far and away the clearest presentation I've seen. When I've tried to explain the new system people have visibly glazed over by the time I got to CSUs so will now direct them here. Many thanks. Given the frequency of NHS structural change have you done it in watercolours?

#40568 Helen Cherry

where are the options to have correct captions on this so deaf and hard of hearing can see to hear whats being said as well as anyone who benefits from captions/subtitles - please remember full access and inclusivity means having captions too!

#40569 Morag Evans
Library Assistant
Dorset County Hospital Foundation Trust

This is a super animation. As a relatively new employee of the NHS I found your portrayal of the structure of the organisation really informative and easy to understand. Is it possible to download a copy of the poster your artists created? It would be handy to refer to it when I get confused about who's who and what's what!!

#40570 Clive Britton
AgeUK South Lakeland

An inspired animation which makes real sense. As a Chartered Mechanical Engineer I can only wonder: will it work. Perhaps there need to be some gear wheels that mesh together.

#40571 sarah.tucker
Digital Communications Officer
The King's Fund
Hi Helen. Thanks for your comment - we are looking into getting transcripts of our animation/videos created. Please do check back soon.
#40572 sarah.tucker
Digital Communications Officer
The King's Fund
Thanks Morag, glad you like it! We'll have JPEG images of the animation available very soon, and will send through to you.
#40573 Mel Pickup
Chief Executive
Warrington and Halton Hospitals NHS Trust

This is Fabulous. Can you make a poster of the finished product, my wall is crying out for it?

#40576 Lynne heal
Disabled with SPMS

Very well explained .On political matters have had over 200 anntedotes deleted ! one to David Cameron I did I printed off as proof

#40582 Carl Peachey
Communications Manager
TRUSTECH - The North West NHS Innovation Service

Wonderful video, well done to all involved with its production! We'll be sharing this widely.

#40583 Nish Soni
Telehealth Lead

Hi, would you also be able to send me the JPEGs when they are ready? Really useful overview, thanks.

#40584 Mark Nicholl
Lean Six Sigma

Clearest presentation I have seen around the new structure - I would love to have a high res copy of the final image too please Sarah.

#40585 sarah.tucker
Digital Communications Officer
The King's Fund
Hi Mel, Nish and Mark - yes sure, will send the final image through. Will also add the JPEG to this page too so it can be downloaded. Thanks, Sarah.
#40586 Penny Fuller
Lead OT
James Paget University Hospital, Gorleston

A brilliant animation. Very helpful to visualise the complex changes we are grappling with. I would echo the comment/request for downloadable posters of the animations to refer back to. Thank you

#40587 Jon Wilkinson
Online Channels Manager

very interesting, thanks. at the instruction of one of our Deans i have posted this on our communications portal where Doctors in Postgraduate Medical training in London will see it.

#40589 N Gillard
Health strategy & planning
Brackley Investments Ltd

Excellent explanation of the new order. However, NHS Property Services Ltd is conspicuous by its absence, which seems to be in keeping with the apparent disconnect between service improvement and premises improvement. The policy approach of care closer to home and shifting appropriate activity from a secondary to primary/community based setting is not being enabled by the lack of development in suitable premises.

#40590 Silvia Bustamante

The video looks like so interesting and useful. Please can you translate to spanish language

#40594 sarah.tucker
Digital Communications Officer
The King's Fund
Hi all - I've added the final animation image showing the new NHS structures. You can download under the 'Further resources on the new NHS' heading above. Thanks, Sarah
#40595 Simon

Great animation - it would be nice to have a copy of the final drawing of the whole structure

#40597 Liz Thiebe

Liz, this is really useful. well done! will be posting this to our MSc students

#40598 Marilyn Boggust
King Fund Associate

Liz, a great way to explain the complexity of the new NHS, well presented and informative - thanks

#40599 Sally Watts
Head of Communications
Northampton General Hospital NHS Trust

What a great video. Will be signposting our staff and our members to this. A poster/jpeg that we could share would be great!

#40600 Ann Leitch
CEO The Insight Network
Spire Healthcare

An excellent overview - thank you!

#40603 Neela Shabde
clinical director- commissioning children & families
Cumbria CCG

Absolutely wonderful way to depict the new changes in the NHS. Well done !

#40604 Oksana Hoile
Senior Manager
Essex & Hertfordshire CLRN

Excellent description of the new NHS and some hints about what things could look like in the near future. Truly well done King's Fund! I will definitely share this animation with colleagues in NHS and academia. Many thanks.

... and well done Liz - what a talent! There should be an award for speed and clarity when communicating complex messages.

#40607 Dr Matt Morgan
Hospital doctor

Fantastic! Please can we have one for the Welsh system . . .

#40609 Bruce Renfrew
Creative Director
Renfrew Group International

Well conceived and good to see the old hand drawing skills making a come-back! I think it outshines any dry flowchart – I also agree with others, the final image should be available for download - Thanks

#40610 sarah.tucker
Digital Communications Officer
The King's Fund
Hi Simon, Sally and Bruce - the final animation image, showing the structure of the new NHS, is available to download underneath the animation as a PDF. Thanks Sarah
#40611 Pauline Mardle
CCG exec/Practice Manager
Lincolnshire West CCG

This is really good I am constantly saying "don't assume everyone understands" I would like to circulate this to all our practices for staff working on the front line


HI i need information about program

#40613 trevor clower
Volunteer Parent Carer
Nottingham Carers Forum & Nottingham Mencap & Disability Direct & Nottingham Health Trust & Nottingham City Care & Nottingham City Learning Disability Partnership Board

This is a ground moving way of explaining the NHS process, not only through clear animation but in clear and concise none jargon way. Liz Saunders, your voice is very easy listen to, thought you talk rather fast. But with enough replays I have managed to keep up with your brilliant description. I would like to thank all the people who have bought this together, you have done something really special here! I belong to a myriad of Care Groups in an attempt to make thing happen at a local level and in 20 years of dealing with Health and Social Services, this is the best message I have come across and intend to bring to all the groups attention. Can I ask one question... can you apply the same process to area's such as Social Services and Health's Self Directed Budgets and the Disability Benefits System?

#40614 Ewan Davis
Woodcote Consulting

Brilliant, but could you do a version that explains how 15 Academic Health Science Networks (AHSNs) fit into the picture?

#40617 Sten

very good overview, (a bit too high speed for a foreign doctor like me but it can obv be seen again ;-)) Will show it to my daughter who is studying the NHS system/health care at school.

#40618 Sue Wright
Clinical Manager
Saint James Dental Centre

Great animation but no mention of how dental provision fits into the mix.

#40619 Sara Nelson
Quality Improvement lead
London Strategic Clinical networks

Great overview of this complex system, well done. Bit disappointed there's no mention of how the Strategic Clinical Networks or the Academic Health Science Networks fit into the system

#40620 jen.thorley
Digital Communications Manager
The King's Fund
We have now added closed captions to this animation on our YouTube channel. We would recommend watching this in full screen. You can view the animation at: Many thanks, Jen
#40621 marie lebacq
senior lecturer
Manchester Metropolitan University

An excellent animation . It will help explain the current provision to my Childhood and Youth Studies students - could do with a pause replay facility to go over the complexities covered. Thanks

#40622 cecilia norman
volunteer teacher
University of the Third Age

Loved the presentation , I cannot believe that the NHS is so complex. The commentary was much too fast to enable me to take in all the information.

#40623 Helen
health professional
NHS trust

Thank you Katie, Sarah and Jen for providing captions responding to request - has made all the difference for me to 'see to hear' spoken words with the brilliant animation of such a fast complex structure.

#40624 Davie Hay

Excellent. Are there plans for similar informative diagrams for the other Home Countries and other European countries to compare and contrast the complexity and commonalities of the system(s)?

#40628 Andy Buttery
Specialist Trainer
Trent Simulation & Clinical Skills

Bravo. Not cynical. When will politicians learn that re-organisation is not the answer to a (group of) QA problem(s)?

#40634 Kath Warren
Nurse Lecturer
Sheffield Hallam University

Thank you, excellent animation. This will be really beneficial to establish the context of the NHS for Nursing Students,
Kind regards

#40643 James Courtney

A brilliant presentation that perfectly captures what a total disaster these reforms have been

#40647 Ruffat Ali-Noor
Governor NHS Berkshire
As above

It is harsh fact that the complexity of this system is very difficult to explain but this excellent animation has done wonders, in such a short time the concept of NHS is given with great clarity.

#40654 Da Young

Thank you, what a great way of showing the new structure!
Could I please have JPEG images of the animation?

Kind Regards
Da Young

#40656 Mandy Davis
Leadership & OD
Lancashire Teaching Hospitals NHS FT

Hi - I think this is a fantastic way of explaining a very complex system in an engaging way. I can see lots of ways in which we can utilise this presentation to help staff understand 'the bigger picture' too.

Which company did you use for the animation?

#40661 john m jack
music producer
Cadillac Music & Publishing Ltd

The NHS has been the greatest addition to British society in the past hundred years; and a unique creation and
inspiration to the rest of the world. Both I and my beloved partner of some 34 years together owe our lives ,and subsequent current quality of health in our advancing years to the unstinted care the NHS has given us .
We are prepared to fight with any and all means at our disposal all attempts to destroy the service.
The NHS is Britain and assaults on it by politicians and their commercial masters should be seen as what they are TREASON.

#40665 Jan
Associate Director
Strategic Clinical Networks

Great video, however, I think you have mixed up the Senates and the Strategic Clinical Networks. For the example given for advice around cardiac services, I would expect the CCG to talk to the Cardiovascular SCN not the Senate. The Senate is there for large strategic, complex change and difficult issues across the whole Senate footprint.

#40667 Angie
I am retired
PPG member

An excellent animation, but sadly it just goes to prove that one set of complex structures is replaced by an even larger set of complex structures within the NHS (at great expense to the taxpayer)

#40672 Dora Kostiuk
Epilepsy Action

Hi Trevor,
I think that the animation helps to demonstrate how complex the hierarchy of the NHS is and makes it almost manageable.


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