An alternative guide to the new NHS in England

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Part of The King's Fund animationsThe 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

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)?

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