House of Commons Library

The structure of the NHS in England

Published Thursday, March 10, 2016

Major reforms to the structure of the health service in England were introduced by the Health and Social Care Act 2012, with a large number of new organisations established on 1 April 2013. This Library briefing provides an overview of the funding and accountability relationships under the new system, and an introduction to the roles of key organisations. This briefing also highlights some of the key health policy issues for the current Parliament, including patient safety, funding, and the integration of health and social care.

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The Health and Social Care Act 2012 introduced the most wide-ranging and controversial reform to the structure of the NHS since the service was established in 1948. The 2012 Act implemented the major reforms to the health service that were outlined in the July 2010 White Paper Equity and excellence: Liberating the NHS. This set out the 2010 Government’s aims to reduce central control of the NHS, to engage doctors in the commissioning of health services, and to give patients greater choice.

The 2012 Act gave General Practitioners and other health professionals responsibility for commissioning the majority of health services, created an independent NHS Commissioning Board (now known as NHS England), and gave local authorities responsibilities for public health and for coordinating local NHS services, social care and health improvement.

The 2012 Act also established Monitor, previously the independent regulator of Foundation Trusts, as the “sector regulator” for NHS-funded services. Monitor is now responsible for tackling anti-competitive practices and for enabling better integration of care. As well as helping commissioners to ensure that essential local services continue if providers get into financial difficulty, Monitor works alongside the quality and safety regulator, the Care Quality Commission (CQC) to take remedial action when CQC reports that a hospital trust is failing to provide good quality care.

Another major driver of change in the last Parliament was the Francis Report into the failings at Mid Staffordshire NHS Foundation Trust, which was published in 2013. The health related provisions in the Care Act 2014 largely address specific recommendations from the Francis Report – specifically about transparency and care standards.

The NHS England Five Year Forward View, published in October 2014, identifies three key drivers for change across the NHS: health and wellbeing, care and quality, and funding and efficiency. It sets out a new central-local partnership to support and stimulate the creation of new care models that can be deployed in different combinations locally across England.

This Library briefing provides an overview of the funding and accountability relationships under the new system, and an introduction to the roles of key organisations, including:
• The responsibilities of NHS England and Clinical Commissioning Groups (CCGs)
• Monitor and the Care Quality Commission (CQC) and the regulation of health services
• Public Health England and local authorities’ public health duties
• Health and Wellbeing Boards and the co-ordination of health and social care services
• The National Institute for Health and Care Excellence (NICE) and access to treatment

Health policy is a largely devolved matter and this note is concerned with the structure of the NHS in England, however, a brief summary (with links to further information) on the health systems in the other parts of the UK is also included.

This briefing also highlights some of the key health policy issues for the current Parliament, including patient safety, funding, and the integration of health and social care. The House of Commons Library’s Key Issues for the 2015 Parliament also contains sections on NHS funding and productivity and on integrating health and social care.

Commons Briefing papers CBP-7206

Author: Tom Powell

Topics: Health finance, Health services

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