The structure of the NHS in England

This briefing explains how the NHS in England works and introduces key NHS organisations and functions, including:

• NHS England, which provides national leadership and oversight for the health service.
• Providers of NHS services, including NHS trusts, foundation trusts, primary care organisations, and private and voluntary sector providers.
• The Care Quality Commission (CQC), and wider patient safety regulation.
• Changes to national public health bodies following the Covid-19 pandemic, and local authorities’ public health duties.
• The NHS Constitution and access to treatment.
• The National Institute for Health and Care Excellence (NICE), an independent public body that publishes guidance on health and social care.

Integrated care systems and local partnerships

The Health and Social Care Act 2022 made extensive changes to the structure of the NHS in England. In particular, the Act established 42 integrated care systems (ICSs) across England. These took on statutory responsibility for most local NHS services on 1 July 2022. ICSs are also responsible for improving the health of the local population, and for integrating health and social care services.

Within ICSs there are a range of local arrangements to plan and deliver joined-up services. These include ‘place-based partnerships’, and primary care networks, which are groups of GP practices. These partnerships and networks also involve community, mental health, social care, and hospital services working together.

Key issues facing the NHS

In its 75^th year the NHS continues to face rising costs of new drugs and treatments, and increased demand from an ageing and growing population. Declining performance in several areas such as the proportion of patinets waiting over 18-weeks for hospital treatment have been made far worse by the coronavirus pandemic. Although some recent improvements have been observed, a return to pre-pandemic performance is not yet evident.

The briefing highlights these and other key issues facing the service, and government and NHS plans to address performance and waiting time pressures. It also provides information on proposals for further change, including plans for a new major conditions strategy, to reform the regulation of healthcare professionals, and to replace NHS procurement rules.

Responsibility and accountability

As well as setting out how the NHS is accountable to ministers, Parliament and the public, the briefing notes the role of local authorities, the CQC, health and wellbeing boards and others in providing accountability across the health and care system.

Health policy is a largely devolved matter and the briefing is primarily concerned with the structure of the NHS in England. A short overview of the health systems in the other parts of the UK (with links to further information) is included in section 12.

Related Library briefings

Detailed analysis of NHS demand and performance indicators for England can be found in the Commons Library’s quarterly publication, NHS Key Statistics: England.

A separate Library briefing provides information on the NHS workforce in England, including NHS England’s Long Term Workforce Plan, published on 30 June 2023.

More detailed information on the provisions of the Health and Care Act 2022 can be found in the Library briefing: Health and Care Act 2022: Final stages in Parliament.

While this briefing refers to policies to promote joint working between health and social care in England, the following Library briefings provide further background on adult social care policy and proposals for reform:

• Proposed adult social care charging reforms (including cap on care costs)
• Adult social care funding (England)
• Adult social care workforce in England