An alternative guide to the new NHS in England

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Part of The King's Fund animationsThe NHS at 65

Article information

  • 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

Dr P.S. Jarrett

Position
GP,
Comment date
04 November 2014
This is lovely! I will be sharing the link. My only caveat is that you rush the end, and gloss over the multiplicity of regulatory bodies which now exist, with overlapping roles, each of which thinks they are the most important. In primary care, we are overwhelmed with the list of demands they make on us. The skeleton staff at NHS England, who are supposed to be commisioning primary care, do not have the resources to do this properly, and also make demands, while failing to support us in the way that PCTs (and before that health authorities) did. The further confusion with NHS England is that they devolve some of their responsibilties back to CCGs... so we end up not knowing who is responsible for what. We have both overlap, and gaps... At least with the old heirarchical structure, for all it faults, lines of responsibilty were clear.

Sandra Ogunsanya

Position
student nurse,
Organisation
king's college london
Comment date
29 January 2015
The animation is fabulous, easy to understand and a timely one for that matter. Prior to this presentation, I found it difficult to comprehend the complexities of the NHS system but after watching it, my knowledge has increased and will definitely inform my future practice. Well done.

Piers Rutterford

Position
Partner/Graphic Designer,
Organisation
Piers & Dominic
Comment date
07 July 2015
Informative content delivered in a captivating way. Given politicians penchant for tinkering, inking it in shows a possible misplaced confidence. Pencil is easier to rub out ;)

humaiyo

Position
techer,
Organisation
noor ji
Comment date
20 July 2015
Your article was very good to me, I will be very grateful thank you very much for posting such a device.
multilingual SEO

Kaye Saxton-Lea

Position
Learning and Organisational Development Business Partner,
Organisation
Basildon & Thurrock University Foundation Hospital
Comment date
17 August 2015
I have found this video extremely useful and use regularly , please can you advise you are planning an update following the election to reflect changes

awaters

Position
Digital Communications Assistant,
Organisation
The King's Fund
Comment date
17 August 2015
Hi Kaye, thanks for your comment. We are considering the possibility of an update, but don't have any set date for this at present. Written updates can be found below the video.

e brown

Position
retired nurse,
Organisation
none
Comment date
05 March 2017
this really proves that all the money for NHS is wasted by more & more bosses etc who take large wages and so there is less money for actual working staff in the NHS.
What about the will of the people, all we get today is hospitals & other vital services closing down as someone has decided people are better at home. Yes this is true but only if well, safe & fit to so. No one wants to go to hospital but if you are ill and need monitoring, treatment , investigations & time to recover you need to be in hospital & have the care you require. A hospital that has empty beds & close enough for family & friends to visit you & take care of your personal needs such as supplying a laundry service & other things you need.
Why are so many jobs created for people to oversee & earn more money than those who do the work?

Simon Napper

Position
Graphic Designer,
Organisation
West Sussex County Council
Comment date
21 August 2017
Hi - the animation is really good - can I ask who produced/made it? We have a client who is interested in doing something similar. Thank you!

awaters

Position
Digital Communications Assistant,
Organisation
The King's Fund
Comment date
21 August 2017
Hi Simon, I’m glad that you enjoyed the animation – it was made by Creative Connection http://creativeconnection.co.uk/. You can see more about their work with the Fund here: http://creativeconnection.co.uk/case-studies/the-kings-fund/.
Anna

Mark Donald

Position
Senior Caseworker,
Organisation
Parliamentary and Health Service Ombudsman
Comment date
07 September 2017
An excellent video. So good, we would like to use it as part of the refresher training we are giving to our experienced PHSO staff and the induction training we will be delivering to new starts. Are you happy with PHSO using your video for this purpose? If so, can we have a version we can download and embed into our intranet page? The reason we need a downloadable version is because if we try to play the video the images can be quite clunky and the sound drops in and out. This is due to our internet configuration which makes it difficult to view video content from an external source. Everything works better if the content can be sourced directly from our internal system. Kind Regards. Mark

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