An alternative guide to the new NHS in England

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Part of Alternative guides to health careThe NHS at 65

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 and we are currently working on a new version to be launched in autumn 2017.

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.

Nish Soni

Position
Telehealth Lead,
Organisation
MSD
Comment date
01 July 2013
Hi, would you also be able to send me the JPEGs when they are ready? Really useful overview, thanks.

Mark Nicholl

Position
Lean Six Sigma,
Organisation
3M
Comment date
01 July 2013
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.

sarah.tucker

Position
Digital Communications Officer,
Organisation
The King's Fund
Comment date
01 July 2013
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.

Penny Fuller

Position
Lead OT,
Organisation
James Paget University Hospital, Gorleston
Comment date
01 July 2013
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

Jon Wilkinson

Position
Online Channels Manager,
Comment date
01 July 2013
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.

N Gillard

Position
Health strategy & planning,
Organisation
Brackley Investments Ltd
Comment date
02 July 2013
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.

Silvia Bustamante

Position
Docente,
Organisation
UPCH
Comment date
02 July 2013
The video looks like so interesting and useful. Please can you translate to spanish language

sarah.tucker

Position
Digital Communications Officer,
Organisation
The King's Fund
Comment date
03 July 2013
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

Simon

Comment date
03 July 2013
Great animation - it would be nice to have a copy of the final drawing of the whole structure

Liz Thiebe

Comment date
04 July 2013
Liz, this is really useful. well done! will be posting this to our MSc students

Marilyn Boggust

Position
King Fund Associate,
Comment date
04 July 2013
Liz, a great way to explain the complexity of the new NHS, well presented and informative - thanks

Sally Watts

Position
Head of Communications,
Organisation
Northampton General Hospital NHS Trust
Comment date
04 July 2013
What a great video. Will be signposting our staff and our members to this. A poster/jpeg that we could share would be great!

Ann Leitch

Position
CEO The Insight Network,
Organisation
Spire Healthcare
Comment date
04 July 2013
An excellent overview - thank you!

Neela Shabde

Position
clinical director- commissioning children & families,
Organisation
Cumbria CCG
Comment date
04 July 2013
Absolutely wonderful way to depict the new changes in the NHS. Well done !

Oksana Hoile

Position
Senior Manager,
Organisation
Essex & Hertfordshire CLRN
Comment date
04 July 2013
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.

Dr Matt Morgan

Position
Hospital doctor,
Comment date
04 July 2013
Fantastic! Please can we have one for the Welsh system . . .

Bruce Renfrew

Position
Creative Director,
Organisation
Renfrew Group International
Comment date
05 July 2013
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

sarah.tucker

Position
Digital Communications Officer,
Organisation
The King's Fund
Comment date
05 July 2013
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

Pauline Mardle

Position
CCG exec/Practice Manager,
Organisation
Lincolnshire West CCG
Comment date
05 July 2013
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

RUBINA TAREEN

Position
DIRECTOR,
Organisation
SMART WOMEN COMMUNITY CENTRE
Comment date
05 July 2013
HI i need information about program

trevor clower

Position
Volunteer Parent Carer,
Organisation
Nottingham Carers Forum & Nottingham Mencap & Disability Direct & Nottingham Health Trust & Nottingham City Care & Nottingham City Learning Disability Partnership Board
Comment date
06 July 2013
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?

Ewan Davis

Position
Director,
Organisation
Woodcote Consulting
Comment date
06 July 2013
Brilliant, but could you do a version that explains how 15 Academic Health Science Networks (AHSNs) fit into the picture?

Sten

Comment date
08 July 2013
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.

Sue Wright

Position
Clinical Manager,
Organisation
Saint James Dental Centre
Comment date
08 July 2013
Great animation but no mention of how dental provision fits into the mix.

Sara Nelson

Position
Quality Improvement lead,
Organisation
London Strategic Clinical networks
Comment date
08 July 2013
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

jen.thorley

Position
Digital Communications Manager,
Organisation
The King's Fund
Comment date
08 July 2013
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: http://bit.ly/12dcl2E

Many thanks,

Jen

marie lebacq

Position
senior lecturer,
Organisation
Manchester Metropolitan University
Comment date
08 July 2013
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

cecilia norman

Position
volunteer teacher,
Organisation
University of the Third Age
Comment date
08 July 2013
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.

Helen

Position
health professional,
Organisation
NHS trust
Comment date
09 July 2013
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.

Davie Hay

Comment date
09 July 2013
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)?

Andy Buttery

Position
Specialist Trainer,
Organisation
Trent Simulation & Clinical Skills
Comment date
09 July 2013
Bravo. Not cynical. When will politicians learn that re-organisation is not the answer to a (group of) QA problem(s)?

Kath Warren

Position
Nurse Lecturer,
Organisation
Sheffield Hallam University
Comment date
11 July 2013
Thank you, excellent animation. This will be really beneficial to establish the context of the NHS for Nursing Students,
Kind regards
Kath

James Courtney

Comment date
12 July 2013
A brilliant presentation that perfectly captures what a total disaster these reforms have been

Ruffat Ali-Noor

Position
Governor NHS Berkshire,
Organisation
As above
Comment date
13 July 2013
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.

Da Young

Comment date
16 July 2013
Thank you, what a great way of showing the new structure!
Could I please have JPEG images of the animation?

Kind Regards
Da Young

Mandy Davis

Position
Leadership & OD,
Organisation
Lancashire Teaching Hospitals NHS FT
Comment date
16 July 2013
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?

john m jack

Position
music producer,
Organisation
Cadillac Music & Publishing Ltd
Comment date
18 July 2013
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.

Jan

Position
Associate Director,
Organisation
Strategic Clinical Networks
Comment date
19 July 2013
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.

Angie

Position
I am retired,
Organisation
PPG member
Comment date
19 July 2013
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)

Dora Kostiuk

Position
retired,
Organisation
Epilepsy Action
Comment date
21 July 2013
Hi Trevor,
I think that the animation helps to demonstrate how complex the hierarchy of the NHS is and makes it almost manageable.
Dora

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