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Understanding the system

The NHS in England is complex with various streams of funding and providers of care. This page provides you with an overview as a starting point for understanding the system.


Strategy

The strategy driving the system in England comes from the Five Year Forward View (FYFV) developed in 2014 and then reviewed in the next steps to the forward view in 2017.

In addition, NHS England also published the Five Year forward view for mental health  This sets out to improve the provision of mental health services, improve the funding available and raise the profile of mental health. The work is overseen by the NHS mental health taskforce. 


To understand how this is being implemented see our Sustainability and Transformation Partnerships (STPs) page. The STPs are developing into Accountable Care Systems (ACS) – alliances of providers and commissioners within a geographical area working together to meet the needs of a defined population.

ACSs are seen as the first step between the STP and becoming an Accountable Care Organisation (ACO) – a multidisciplinary and multi service with a single single-provider having overall responsibility for managing the service, including the funding, resources, staff and patients services. The Kings Fund has further information on 
Accountable Care Organisations (ACOs)

Another key driver is to reduce variation in care to improve quality and safety across the system. The NHS Atlas of Variation in Healthcare tool identifies where opportunities to address unwarranted variation exist, by revealing the possible over-use and under-use of different aspects of healthcare.

NHS Right Care uses evidence on outcomes and variation to make sure care is delivered in the best way possible. Getting it Right First Time (GIRFT) is a programme that also builds on variation in clinical specialities and practice to support implementation of what works.


Sustainability and Transformation Partnerships (STPs)

STPs

Plans that deliver the aims of the Five Year Forward View in different localities.

Workforce support and development for integrated care

Having enough staff with the right skills and appropriate mix of skills to meet the health and social care needs of the population is an ongoing challenge within the NHS. 

The nursing workforce is vital to enabling the successful integration of care in the workplace and within local areas. Right staff, with the right skills, in the right place at the right time. 

In July 2016, the National Quality Board (NQB) published “Supporting NHS providers to deliver the right staff, with the right skills, in the right place at the right time: Safe, sustainable and productive staffing.

Health Education England’s (HEE) role is to support the delivery of excellent healthcare and health improvement to the patients and public of England by ensuring that the workforce of today and tomorrow has the right numbers, skills, values and behaviours, at the right time and in the right place. 
 

Safe staffing

Safe staffing

Nursing staff shortages are compromising patient care. Find out about our safe staffing work and how you can get involved.


Safe staffing

Regionally the Local Education and Training Board (LETBs) are responsible for the delivery of HEE work Training and education of doctors, nurses, dentists and all healthcare professionals. The LETBs committee members are from Health Education England, NHS Employers, and local NHS services providers. The Four LETB’s nationally are:

  • London and the South East
  • The South
  • The Midlands & The East
  • The North
Locally and in development with the local STPs, the: 

Local Workforce Action Boards (LWAB) work strategically to ensure that decisions are made in connection with the workforce of both health and social care are planned effectively at the right time with the correct people involved.

Local Workforce Action Boards (LWAG) work as a sub-group of the LWAB to plan at an operational level the decisions made by the LWAB. 

Community Education Provider Networks CEPN or Training Hubs
as part of HEE bring together all those involved with education and training in primary care within a specified geography. The aim is to deliver and coordinate education and training, promote multi-professional learning, respond to and plan for local priorities and workforce needs.

Integration with local government 

Integration of services, social care and public health is integral to the overall success of integration plans. Liaison and work with Local Authorities (LAs) which can be City, Borough or Local Councils and are responsible for the administration of services within that area and managed by elected local members. Each local Authority will have separate management and strategic aims. The Local Government Association (LGA) is made up of representatives of Local Authorities across England and Wales to share and deliver best practice.


There are two key committees in terms of wider health and social care integration:

Health and Wellbeing Boards (HWBB) are statutory organisations formed under the Health and Social Care Act 2012, They are formed within each local authority area and made up of representatives from across health and social care, public sector organisations such as the police, Healthwatch and other community groups. Their aim is to improve service integration within the geographical areas and reduce health inequalities.

Health Overview and Scrutiny Committees (HoSCs) are statutory under the Health and Social Care Act 2012. Each committee is formed of local councillors as a sub group of the local authority Board. Their purpose is to scrutinise any plans to significantly change delivery of health care. They can call for evidence from the commissioners of the service and the providers to reach a conclusion as to if they agree or have recommendations with regards to the proposed changes. In the event agreement cannot be reached they have the power to refer the matter to the Secretary of State for Health. 
 

Funding

There are various funding streams available for local commissioning of services across health and care:

The Better Care Fund (BCF) is a fund provided by Central Government jointly to Local Authorities and CCG’s to improve health and social care

Integrated Personal Commissioning (IPC) is a joint initiative programme of NHS England and the Local Government Association (LGA) which enables individuals who require a complex care package to commission a personised plan of care from multiple providers. 

Personal Health Budgets (PHB) is an amount of money to support the identified healthcare and wellbeing needs of an individual, which is planned and agreed between the individual, or their representative, and the local clinical commissioning group (CCG). At the centre of a personal health budget is the care and support plan.
 

Public and patient engagement

Engagement with the public in health and care plans is essential and there are various mechanisms to support this:

Healthwatch is a statutory body formed under the Health and Social Care Act 2012. Each local authority area has a local Healthwatch who works to ensure that the voice of the public and the needs of the community are served by health and social care providers and commissioners. 

Public Patient Experience/ Public patient Engagement (PPE) describes the increasing need to make sure that the public, patients and service users are engaged in designing services most appropriate for their needs. The Kings Fund has further information on PPE. 

From April 2016, it has been a contractual requirement for all English general practices to form a patient participation group (PPG)
 
FFT (Friends and family Test) is a feedback tool to support users of a service to report back on experiences.

Other organisations with useful information

NHS Choicesfurther information on the structure of the NHS

NHS Englandhas a helpful introduction to the NHS 

NHS Clinical Commissioners - the membership organisation of clinical commissioning groups

New NHS Alliance  - a movement of people and organisations committed to building a sustainable, community-based health service

Carers UK - a national membership charity for carers.