The Structure & the Future of the NHS Explained 

The National Health Service (NHS) is the UK’s publicly funded healthcare system. It was established in 1948 to provide free healthcare to all residents of the UK. The NHS has undergone numerous changes in structure and function over the years. In this article, we will look at the structure of the NHS, how it has changed over time, and how it could evolve in the future.

Structure of the NHS:

The NHS is a complex organisation that consists of many different components. The main components are as follows:

1. Department of Health and Social Care: The Department of Health and Social Care is responsible for the overall management and direction of the NHS. It sets policies and provides funding for the NHS.
2. NHS England: NHS England is responsible for commissioning healthcare services in England. It is also responsible for the performance of the NHS in England.
3. NHS Scotland: NHS Scotland is responsible for providing healthcare services in Scotland.
4. NHS Wales: NHS Wales is responsible for providing healthcare services in Wales.
5. Health and Social Care Northern Ireland: Health and Social Care Northern Ireland provide healthcare services in Northern Ireland.
6. Clinical Commissioning Groups (CCGs): CCGs are responsible for commissioning healthcare services at a local level. Local doctors and nurses lead them.
7. NHS Trusts: NHS Trusts are responsible for providing healthcare services at a local level. They include hospitals, community healthcare services, and mental health services.

What was the initial structure of the National Health Service (NHS)?

The initial structure of the National Health Service (NHS) was established in 1948, and it was based on three core principles:

1. That it would be available to all and financed entirely from taxation.
2. That it would provide a comprehensive range of healthcare services.
3. That it would be free at the point of use.

The NHS was a nationalised system that was centrally managed by the government. The Ministry of Health was responsible for the overall management of the NHS.

• It was divided into regional health authorities, which were responsible for managing and delivering healthcare services at a local level.

• At the local level, the NHS was organised into hospitals, clinics, and general practitioners’ surgeries, which were responsible for delivering primary care services. 

• Hospital services were provided by a mixture of voluntary, municipal, and charitable hospitals, which were brought under the control of the NHS at its inception.

The initial structure of the NHS was designed to provide universal healthcare services that were free at the point of use. 

It was a radical departure from the previous system, which was based on a patchwork of private and charitable healthcare providers. The NHS was widely celebrated as a landmark achievement in social welfare provision and remains a cornerstone of the UK’s social infrastructure.

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How has the structure of NHS changed?

The creation of the National Health Service (NHS) in 1948 brought universal healthcare services to the UK, but over time, changes were made to the NHS structure to address challenges in delivering high-quality, affordable care.

One of the most significant changes came in the 1980s when The Black Report revealed that despite the NHS’s foundation, there were disparities in healthcare outcomes between wealthier and poorer communities. This report prompted the Thatcher government to introduce the concept of an ‘internal market’ to govern the NHS.

Under the NHS and Community Care Act 1990, regional health authorities were given budgets to buy health services from hospitals and other healthcare providers, introducing competition between hospitals to sell their services. This change was designed to encourage efficiency and reduce costs.

In 2003, the Labour government introduced Payment by Results, which allocated funding to NHS bodies based on the number of patients they treated. While this system can be cost-efficient, it may prioritise meeting targets over providing high-quality care.

Overall, the NHS structure has evolved to address changing healthcare needs and funding challenges. As advances in medical science drive up costs, the NHS may need to continue adapting its structure to ensure that it can provide high-quality care for all.

Changes in the NHS Structure over time:

The Health and Social Care Act of 2012 brought significant structural changes to the NHS. Today, the NHS comprises several organisations working at local and national levels. NHS England’s structure includes the following:

The Department for Health is responsible for healthcare funding and policy in the UK.

Sustainability and Transformation Partnerships (STPs)

One of the most notable changes introduced by the 2012 Act was the establishment of Sustainability and Transformation Partnerships (STPs) in 2016. 

STPs are responsible for bringing together various NHS providers, commissioners, local authorities, and other partners to plan healthcare services based on the long-term needs of local populations. 

STPs cover areas with populations ranging from 1-3 million people.

Integrated Care Systems (ICSs)

Integrated Care Systems (ICSs) are evolving from STPs in some areas, and the NHS Long Term Plan confirmed that an ICS would cover every part of England by April 2021. 

ICSs are a closer collaboration where organisations take on more responsibility for resources and the care of the local population.

Clinical Commissioning Groups (CCGs)

Clinical Commissioning Groups (CCGs) are another significant element of the NHS structure. They cover a specific geographical area and are responsible for commissioning most NHS services. 

In 2020, there were 135 CCGs following a series of mergers. Each group decides which services and treatments are available in their hospitals and chooses how secondary care is provided.

NHS England

NHS England is an independent governing body that oversees healthcare. It ensures an effective system of CCGs and must provide support for commissioning. In 2019, NHS England and NHS Improvement were merged but maintained separate boards.

NHS Foundation Trusts

NHS Foundation Trusts provide care that the CCGs commission, including hospital, ambulance, mental health, social care, and primary care services.

Primary Care

Primary Care is delivered by general practitioners who work holistically, thinking of a patient in their entirety. Since July 2019, almost all GP practices in England have come together to form about 1,300 primary care networks (PCNs). 

These networks cover a population of 30,000-50,000 people and bring general practices together with local providers to provide a wide range of professional skills and community services.

Secondary Care

Secondary Care is provided by specialists and healthcare professionals to whom patients are often referred through a GP. 

It includes both emergency and non-emergency hospital contacts such as A&E, routine outpatient clinics, and mental and maternity health access.

Tertiary Care

Specialised doctors and nurses provide tertiary care in hospitals such as plastic surgery units. Patients can only access tertiary care if they are referred by a health professional working in secondary care.

The National Institute for Health and Care Excellence (NICE) 

The National Institute for Health and Care Excellence (NICE) evaluates the most up-to-date evidence behind treatments and details the best approaches, putting prospective treatments through rigorous analysis and evaluation. 

CCGs are legally obligated to make funding available for treatments recommended by NICE following publication.

The Care Quality Commission (CQC)

The Care Quality Commission (CQC) is an independent monitoring agency inspecting the safety and quality of care in hospitals, general practices, care homes, ambulance services, and walk-in centres, then delivering a publicly available evaluation. 

Department of Health and Social Care (DHSC)

The CQC reports to the Department of Health and Social Care (DHSC) and aims to improve the quality of healthcare providers across the UK. It publishes ratings of each trust and its services. If services do not meet specific standards, the CQC can issue warnings, restrict services, or even prosecute the provider.

Health Education England 

Health Education England is the overseeing body for the lifelong training and education of the NHS workforce, committed to “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.”

In January 2019, the NHS set out its long-term plan, which outlines the key ambitions for the service over the next 10 years. Its aims include giving people more control over their health and the care they receive, as well as encouraging Integrated Care Systems.

Future of NHS – The Devolved Healthcare System:

The NHS is likely to undergo further changes in the future. Some of the changes that are being considered are as follows:

Another proposed change that could significantly affect the NHS’s structure is the idea of more devolved healthcare. Devolved healthcare means that healthcare services are managed at a more local level rather than at a national level. It is often proposed as a way of making healthcare services more responsive to the needs of local people and making sure that resources are being used effectively.

In 2014, a report by the think-tank IPPR proposed that healthcare services in England should be devolved to local authorities, with funding for health and social care merged. The report argued that this would enable local authorities to better integrate health and social care services and ensure that resources are used effectively.

In 2018, the government announced plans to pilot a new model of devolved healthcare in Greater Manchester. Under the new model, local authorities in Greater Manchester would take control of a £6bn health and social care budget, with responsibility for commissioning services. 

The aim of the pilot is to improve coordination between health and social care services and ensure that services are better tailored to the needs of local people.

The success of the Greater Manchester pilot could lead to further devolution of healthcare services in other parts of the country. However, there are concerns that devolved healthcare could lead to a postcode lottery, with access to healthcare services varying depending on where people live.

The structure of the NHS has changed significantly over the years, from its inception in 1948 to the present day. The current structure is complex, with a series of organisations working at a local and national level. The concept of an internal market, introduced in the 1980s, continues to govern the NHS today. 

The NHS is also facing new challenges, such as an ageing population and increasing demand for services, which could require further changes to its structure. Devolved healthcare is one proposed solution that could significantly affect the NHS’s structure in the future.

FAQs

→ Q: Can anyone access NHS services?

A: Yes, in most cases, anyone legally residing in the UK can access NHS services for free at the point of use. This includes emergency treatment, consultations with GPs and other healthcare professionals, and hospital care. There may be some exceptions for certain services, such as dental and optical care.

→ Q: How is the NHS funded?

A: The NHS is funded primarily through general taxation and National Insurance contributions, which are paid by UK residents who are employed or self-employed. The government sets the NHS budget each year, and the funds are distributed to different NHS organisations according to their needs and priorities. The NHS also generates revenue through patient charges, such as prescription fees and elective procedures.