An alternative guide to the new NHS in England

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Part of Alternative guides to health careThe NHS at 65

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  • Posted:Monday 15 July 2013

This animation was created in 2013.  Please watch our updated version, How does the NHS in England work? An alternative guide, which was published in October 2017. 

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 the NHS – how the organisations work and fit together – and explains that our system is as much a product of politics and circumstance as design.

This animation was created in 2013.

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:

Commissioning

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.

Devolution

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.

Regulation

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.

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 courses.

Comments

Lee Bailey

Position
NHS Contractor (PCT/CSU),
Comment date
27 June 2013
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.

Jane King

Comment date
27 June 2013
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?

Helen Cherry

Comment date
28 June 2013
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!

Morag Evans

Position
Library Assistant,
Organisation
Dorset County Hospital Foundation Trust
Comment date
28 June 2013
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!!

Clive Britton

Position
Trustee,
Organisation
AgeUK South Lakeland
Comment date
28 June 2013
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.

sarah.tucker

Position
Digital Communications Officer,
Organisation
The King's Fund
Comment date
28 June 2013
Hi Helen. Thanks for your comment - we are looking into getting transcripts of our animation/videos created. Please do check back soon.

sarah.tucker

Position
Digital Communications Officer,
Organisation
The King's Fund
Comment date
28 June 2013
Thanks Morag, glad you like it! We'll have JPEG images of the animation available very soon, and will send through to you.

Mel Pickup

Position
Chief Executive,
Organisation
Warrington and Halton Hospitals NHS Trust
Comment date
28 June 2013
This is Fabulous. Can you make a poster of the finished product, my wall is crying out for it?

Lynne heal

Position
Disabled with SPMS,
Comment date
29 June 2013
Very well explained .On political matters have had over 200 anntedotes deleted ! one to David Cameron I did I printed off as proof

Carl Peachey

Position
Communications Manager,
Organisation
TRUSTECH - The North West NHS Innovation Service
Comment date
01 July 2013
Wonderful video, well done to all involved with its production! We'll be sharing this widely.

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