Taking Charge of Your Health

How does the NHS in England work? What organisations make it up? And how is it changing over time? Since the NHS is largely funded by our taxes, let’s start with the government. They decide how much money the NHS receives and do top-level priority setting. The Secretary of State for Health is in charge of the Department of Health which has actually quite slimmed down compared to what it used to be. And it passes most of its money on to
a range of other organisations. The lion’s share goes to an organisation
called NHS England. It was created in 2013 as part of sweeping
reforms aimed at improving services by increasing competition, cutting red tape,
and keeping the government out of the day-to-day running of the NHS. But this is all actually quite far from what’s really happening, as we’ll see. NHS England is responsible for overseeing the commissioning, the planning and buying, of NHS services. In practice it also sets quite a lot of NHS strategy and behaves like an NHS headquarters. NHS England commissions
some services itself but passes most of its money on to 200 or so clinical
commissioning groups across England, also known as CCGs, which identify local
health needs and then plan and buy care for people in their area,
people like you and me. CCGs buy services from organisations of
different shapes and sizes, from NHS trusts that run hospitals and community
services, to GPS and others that provide NHS care, including organisations run by
charities in the private sector. Jostling for position alongside NHS England
is NHS Improvement. It oversees NHS trusts and right now its focus is very
much on managing the money. So, for example, it tries to ensure that trusts
keep a lid on costs, operate efficiently and, you know, improve. Also in the mix is the Care Quality Commission, which inspects the quality of care provided. There are also a whole load of other bodies with their own remits and acronyms. This is quite a crowded landscape and the upshot is that these different organisations can at times issue seemingly contradictory messages.
There are also unclear boundaries about exactly which organisation is
responsible for what, prompting questions about who’s really in charge. But the NHS never stays the same for long and the way these organisations work together is changing. The most recent changes started in 2014 when NHS England published a vision for the future of health care called the
NHS five year forward view. This called for more of a focus on preventing people getting ill in the first place and giving patients more control of their own care. It also set out a range of so-called new models of care, that aimed to get services working together to provide joined-up care for patients. There’s not been much progress on the prevention bit but lots of energy has been put behind the new models. These set out to do things like provide care traditionally
delivered in hospitals, like chemotherapy, in people’s homes, and get people to work
differently, for instance dementia specialists carrying out clinics in GP surgeries. This new way of working is particularly designed to help meet the needs of increasing numbers of people who need support to help manage a range
of long-term health conditions, particularly older people. 50 areas across England, known as vanguard sites, have been trialing these different ways of delivering more joined-up care
over the past couple of years. This is all part of a broader shift towards organisations working together more closely to meet patients’ physical and mental health needs and away from
an NHS marketplace. The NHS has invented or adopted a whole array of acronyms to describe this new and evolving approach. Firstly there are STPs, or sustainability
and transformation partnerships, which aren’t things or organisations in
themselves but, as the name suggests, more a way of working together in partnership. These were created when NHS organisations were asked to come together with local authorities, charities and others to agree how to
improve health and modernise services in their patch. There are 44 STPs in England all focused on progressing the ideas set out in the five-year forward view. But they haven’t exactly had an easy birth with accusations of plans being cooked up behind closed doors and driven by financial cuts. Some STP areas are on track to develop into another three-letter acronym, ACS’s, or accountable care systems. These take inspiration from parts of the US where
organisations work together under a set budget to improve health and co-ordinate services for people who live in a particular area. In part these changes are all about managing the limited resources available to the NHS, but they’re also about working together with services outside the NHS, like social care and public health, that have a really important impact
on our health. This requires much closer working with local authorities. Some areas are taking this regional based approach even further, so for example in Greater Manchester, devolution is giving local NHS and council leaders
more control over how health and care services should work there. And across
England we’re also starting to see CCGs merging, hospitals working together in
chains, and GPS forming large groups of practices. So where does this leave us
and what next? Well there’s a lot of change going on
and it throws up loads of unanswered questions not least, what does this all
mean for patients like you and me? Well in some ways nothing much changes.
You’ll still see a GP when you’re ill and there will still be hospital care. But if these changes are successful, you may well get more support and treatment at home rather than having to go to hospital, more help to stay healthy, and you might also get to see a GP quicker. You might see more controversial changes too,
for example you may need to travel further from home to access better
hospital services. All of these changes take time and won’t
be easy, especially when the NHS budget is failing to keep up with the growing
cost of caring for an aging population with increasingly complex health care needs. And when NHS staff are feeling stretched and under pressure. Seventy years after its creation, the NHS continues to be highly valued by the public, with many seeing it as a national treasure. Looking at the bigger picture,
change in the NHS is nothing new and this is just a snapshot of where we are
now. The story will inevitably continue.

28 thoughts on “How does the NHS in England work? An alternative guide

  1. There's at least one false statement within this footage and that is where it states you may have to travel further from home for better hospital services. The fact is you will have to travel further from home for hospital services, yet this does NOT mean that those hospital services are any better at all an in my brothers case and in the case of thousands of patients across the UK they are traveling hundreds of miles from home for hospital services that are that are even worse than local services, yet they have no option or any say on what services they can chose as there is already such a critical lack of mental health beds in the UK. There are patients from England been admitted as far as Scotland, Wales and Ireland and visa versa. The General public need to wake up to the present state of the NHS and the Governments lies of home much they are claiming to help and their sever cuts to funding. The increase of an ageing population is also over used, when in fact the present situation is the lack of funding and the increasing use of private health care and private hospitals. We need to reinstate the NHS Bill. Click on this link and sign the petition REINSTATE THE NHS BILL:

  2. As a startup company director selling digital health innovations into the NHS this is a good founding for finding out further information. More of these please. Thanks.

  3. NHS is a dynamic organisation and has to adapt to public it serves. Changes are essentials and must be well led and planned, which is clearly not happening. Also, change in such a big organisation cannot turn the previous structure upside-down and change direction every few years: the structure has to have time to adapt to the new direction. And finally, changes in the way health is delivered cannot be driven by a choice 'a priori' to cut down the overall cost of the sector. If there were area of inefficiency in the previous model, they will be remodelled, but the idea that giving less money to the NHS will make it more efficient is frankly laughable! What if the new model of care requires the same money (or more money) than the previous one? On what evidence the reduction of Health Care budget from 8.4% to 6.9% GDP was decided in the first place?

  4. Read the truth in my new book 'The Enigma of Determination' and join in the discussions Twitter: @MercuryTrevor and Facebook: @enigmaofdetermination.
    The national health system is failing because of four prime reasons, politicians looking to privatise health care for the benefit of insurance comapanies and private drug suppliers, thus, overloading the NHS with heavy numbers of smooth talking incompetent managers and substantial red tape removing time away from patient care. Two, is people abusing the NHS for every issue that they can easily prevent or treat themselves. Three and ever increasing population bought about by imigration and irresponsible parental decision making by not considering resource availability to number of people. And four, religion giving the false believe that god will provide. Health care is a limited resouce, not unlimited. Everybody is working to make the system fail.

  5. The NHS is one massive cock up. General Practitioners are being given 10 minutes to diagnose and organise treatment for cancer and other very serious illnesses, while working 13 hour days and running off very little sleep. Patients expectations are too high and the NHS simply does not have the budget to improve situations. And none of this will change as long as the NSH being run by a man who has voted on numerous occasions to drop the service entirely. The government is shutting down gp practices by allowing them to run out of money and close down and it is highly likely that general practice will not last much longer than a decade if change does not happen fast.
    People think that making gp an online service will fix the crisis of a lack of doctors but this is simply not feasible. There is a connection made when you are in the room with someone that can never be made through an online service. So much of a persons diagnosis is made based on physical notes made by the doctor. It is crucial that doctors can recognise when a person is hiding, an alcohol problem for instance, and other key factors that could be impacting their symptoms and that they can recognise when the situation is serious and when the person is perhaps a slight hypochondriac.

  6. This is a good explainer, but doesn't mention many of the problems with ACOs and STPs, and doesn't cover the implications of the Government divesting itself of responsibility for the NHS. The planned legislation for ACOs allows private companies into the commissioning and decision making structure of the NHS – this could mean a private health insurer gets to decide where spending goes, shaping the available services and quality of services – a clear conflict of interest. And with Health and Social Care merging, it could mean the introduction of charges as social care is not currently free, it is means tested. Do we want private health insurance companies having the power to move certain services into the social care category so they become chargeable? STPs have been roundly criticised as being uncosted, vague and not fit for purpose. Many see this as preparation for an American-style privatised system, with limited low quality services free at the point of use and and the majority of people moving to private insurance in desperation. I have added two links to illustrate my points. –

  7. Also both the public and parliament should be able to scrutinise ACOs / ACSs before they are rolled out. The govt has just agreed to a public consultation, but (it seems) are still trying to roll out ACOs in certain areas before the consultation completes. It is unclear if they are actually delaying ACOs and the legislation it requires, although obviously they should do so if they are having a national public consultation, otherwise the consultation is meaningless. No parliamentary scrutiny is on offer currently, which is not acceptable given the nature of the changes being proposed.

  8. This video is awful. Its message is 'the NHS is too complicated for you' , showing the NHS in a linear fashion of stepping stones for less than half a second per stone with freshly tossed word salad for the viewers to slip on.

  9. NHS waiting times see Brits flock overseas for PRIVATE treament
    THE NUMBER of patients flying overseas for private medical treatment has quadrupled in four years as NHS waiting times reach record levels.
    By Lucy Johnston, HEALTH EDITOR PUBLISHED: 00:01, Sun, Apr 8, 2018

    NHS waiting times are getting long enough that patients are looking for overseas treatment

    Long waits for surgery such as hip, knee and cataract operations, together with the growing cost of dental care, are fuelling the rise, experts say.

    The figures, calculated for the Sunday Express by the Office for National Statistics, cover the period up to September last year.

    Assuming the trend continued through the final quarter, as many as 211,000 people will have travelled abroad for treatment in 2017 compared with just 48,000 in 2014.

    NHS waiting times are now the longest they have been for almost a decade, with more than 400,000 people waiting more than 18 weeks for treatment – an increase of 60,000 since 2014.

    Eastern Europe is the biggest draw with approximately 18,000 visiting Poland last year – a 50 per cent increase on 2014 – many for plastic or eye surgery.

    Hungary remains a popular spot due to high healthcare standards

    Meanwhile UK visitors to Hungary, where dentistry, fertility services and cosmetic surgery are popular, increased more than threefold to around 19,000 in 2017.

    However, the fastest growing eastern European destination is Bulgaria, which saw a sixfold increase in UK health tourists to 6,000 last year compared with 1,000 in 2015.

    Experts say this is because the country has the most affordable and swiftest access to private health care in the EU.

    Consultant appointments can be made in a couple of hours and results are usually given the same day. Private hospitals also offer the latest minimally invasive surgical techniques, some of which are not yet widely available in the UK.

    These include minimally invasive “anterior approach” hip replacement, which involves a 2½ inch incision and does not require cutting the muscles – leading to a recovery time of two to three weeks.

    This is in contrast to a conventional 12-inch incision, including muscle detachment, and a recovery time of up to seven weeks. UK health tourists to France and Germany increased threefold over the past three years to approximately 9,500 and 5,500 respectively.

    Many of them went seeking hip or knee replacements. Spain saw a dramatic tenfold increase to approximately 9,500 over the same period, many of whom were there for fertility treatment.

    Increasing demand has spawned the growth of a new industry of health tourist operators such as Bulgaria Medical Travel Partner, based in the country’s capital, Sofia.

    It offers patients a round-the-clock concierge service and arranges hotel and hospital bookings for orthopaedic surgery, dental treatment and health screening.

    One of its patients, 50-year-old IT consultant Lee Kane, from Fife, had pioneering dental implant surgery after being told an operation in the UK might not be successful and would cost him over two-thirds more than his treatment there.

    Father-of-one Mr Kane said: “It’s unbelievable. I am so happy I want to break down in tears.”

    Knee and hip replacements remained most popular among health tourists

    In another case, Alan Baker, a 65-year-old mining project manager from Wheatley, Nottinghamshire, had travelled to Macedonia and paid £3,300 for a six-week course of radiotherapy for prostate cancer which would have cost him £35,000 as a private patient in the UK.

    Vesselina Dimova, founder of Bulgaria Medical Travel Partner, said: “It is important that UK health tourists check out the credentials of the clinicians wherever they go for treatment.

    Rogue operators can work in any country, including the UK.

    “Our team has handpicked medical staff and patients are given full credentials of their clinician before they book as well as clear terms and conditions prior to travel.

    “Patients are accompanied by a personal assistant, available daily, who can translate and provide emotional and logistic support.”

    Kailash Chand, honorary vice president of the British Medical Association, warned that if complications did occur abroad, the NHS was often left to clear up the problems.

    He said: “It’s very sad we have brought the NHS to its knees, getting rid of staff while the workload has gone through the roof, which has fuelled the rise in patients going abroad for treatment.

    “We need to sort out our own house. In many cases patients who travel abroad for treatment come back to the NHS for aftercare or complications which are harder to deal with when doctors here do not know what has gone on.”

    The Department of Health said last night: “There are many reasons why people seek treatment abroad and the total number who did so last year is less than 1% of those who began treatment in the UK.”

  10. Thank you for this very informative video.
    Here's a David Hill Guildford video about it.

    Thank you!

  11. GPs made to manage their budgets, hospital services given to the private sector affecting the hospitals budgets, PFIs that eat Hospital budgets,
    "Monitor" overseeing NHS contracts going to the private sector ( 70% of them in 2017) and a Government that still denies that it wants to bust the NHS up for itself and their corporate friends and liberate NHS money to the free market, shareholders and cut patient care to a bare minimum, that's if you don't get kicked off your GPs list because you cost to much to look after…..

  12. It doesn't.

    A nationalised health service brings practitioner's pay down so less people graduate and work within the NHS. More go private or emigrate.

    An obvious consequence is the need for medical staff is solved by open border immigration policies which fill the positions with lesser qualified staff but also increase pressures on the NHS via higher demand/more patients

    As a result we wait longer for a lower quality of care and nationalisation means no competition in medical research and a slowed progress in medical developement.

    New labour already started the privatisation process over 10 years ago to line their pockets creating an inevitable ticking bomb situation or an abyss into which current and future governments must throw increasing amounts of our taxes.

  13. Well done to The Kings Fund for doing their very best to explain this mess, but this organisation is completely bloody ridiculous! Their video should be called 'How DOES the NHS in England work?' Way too many pen-pushers and mouse clickers. 'Jostling for success is NHS Improvement' 'Who's really in charge'. And way too many acronyms and initials ; ACCs, CCGs, PACs, MCPs, AHSNs, CQC… What about this one: WTFIIAA? What the fuck is it all about?

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