This Commons Library briefing provides an overview of the funding and accountability relationships within this NHS in England, and an introduction to the roles of key organisations including NHS England, NHS Improvement and the Care Quality Commission. This briefing also highlights some key health policy issues, including patient safety, funding, and the integration of health and social care.

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Please note the content of this briefing was produced before the Covid-19 pandemic, and focuses on information and data about the NHS before coronavirus response measures were introduced.

The current pandemic has radically reshaped the delivery of health services, and there will likely be long term impacts on the health and wellbeing of both the public and health and social care staff. What the implications will be for how the NHS is organised in the long term remain to be seen, but beyond lessons for future pandemic response, the NHS will need to carefully prioritise resources as it returns to normal activity. There are likely to be significant implications for recently introduced strategies to improve clinical outcomes and tackle workforce issues, as well as greater urgency to calls for social care reform. Other existing trends, such as closer working between local health and care providers, and the move to online working, have been accelerated by system-wide responses to Covid-19. Some changes to ways of working that have been introduced in the NHS over the first weeks of the pandemic response may become a ‘new normal’.

The Commons Library has produced a range of briefings on the response to Covid-19, which are available on the Commons Library website (see for example Coronavirus: health and social care key issues and sources). For the latest information on the UK’s pandemic response you should refer to the coronavirus pages on the Gov.uk and NHS websites.

This Commons Library briefing provides an overview of the funding and accountability relationships in the English NHS, and an introduction to the roles of key organisations, including:

  • NHS England and NHS Improvement, which since April 2019 have provided joint leadership through shared national and regional teams; and
  • Clinical Commissioning Groups (CCGs), which are responsible for most local NHS services.

It also covers:

  • The Care Quality Commission (CQC) and patient safety
  • Health Education England (HEE) and workforce planning, education and training
  • Public Health England (PHE) and local authorities’ public health duties
  • Health and Wellbeing Boards and local authority health scrutiny
  • The NHS Constitution, the National Institute for Health and Care Excellence (NICE), and access to treatment

This briefing highlights key issues in health policy, including the performance, funding and workforce pressures facing the NHS. It also looks at proposals for the redesign and integration of services, reform competition rules, and develop the use of technology and data.

In terms of structural changes, this briefing provides an overview of the extensive changes introduced by the Health and Social Care Act 2012. A number of important non-statutory changes have taken place, and since 2016 these have included:

  • The formation of 42 Sustainability and Transformation Partnerships (STPs) across England, with local health and care organisations coming together to create regional plans. STPs are intended to improve services, promote population health, and enable the NHS to become more financially sustainable.
  • The development of STPs into Integrated Care Systems (ICSs) in 14 areas of England. ICSs are a step towards even closer collaboration between NHS organisations, in partnership with local councils and others. ICSs take collective responsibility for managing resources, and improving population health.
  • The two organisations responsible for setting the direction of the NHS, NHS Improvement and NHS England, have operated as single organisation since April 2019.
  • The announcement of a 5-year funding settlement for the NHS in 2018, and the introduction of an NHS Funding Bill in January 2020.
  • The publication of a 10-year strategic plan, the NHS Long Term Plan, in January 2019.
  • The September 2019 Health Infrastructure Plan set out commitments for additional capital funding to modernise the NHS estate.

Coinciding with the 70th anniversary of the creation of the NHS in 2018, the NHS in England was asked to produce a ten-year plan to improve access, care and outcomes for patients, in return for a five-year funding settlement. The resulting NHS Long Term Plan set out how the NHS should maximise the impact of extra funding. The Plan set objectives for improving public health and clinical outcomes, in areas such as preventing infant mortality, improving cancer survival rates, and better mental health services. To enable these changes, the Plan set out actions on workforce, technology, innovation and efficiency. It also proposed changes to the ‘system architecture’ of the NHS, to increase the coordination of services, with the creation of Integrated Care Systems. This has been seen as a move away from some of the market-based reforms of the Health and Social Care Act 2012, and also a shift from the commissioner/provider split introduced in the early 1990s.

Health policy is a largely devolved matter and this briefing paper is primarily concerned with the structure of the NHS in England, however, a brief summary on the health systems in the other parts of the UK (with links to further information) is also included in section 11 of this briefing.

While this briefing refers to policies to promote joint working between health and social care services in England (see section 10), the following House of Commons Library briefings provide further background on adult social care policy and proposals for reform:

See also the Commons Library briefing paper on health and social care integration.

  • Commons Research Briefing CBP-7206
  • Authors: Elizabeth Parkin, Rachael Harker, Tom Powell
  • Topics: Health, Health services

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