The Department of Health created an interactive diagram which gives an overview of the new health and care system that came into effect in England from April 2013.It illustrates the statutory bodies which make up the new system, oriented around people and communities and where they receive their local health and care services.
The Secretary of State for Health
The Secretary of State for Health has ultimate responsibility for the provision of a comprehensive health service in England and ensuring the whole system works together to respond to the priorities of communities and meet the needs of patients.
The Department of Health
The Department of Health is responsible for the strategic leadership of both the health and social care systems, but will no longer be the headquarters of the NHS, nor will it directly manage any NHS organisations. For detailed information about the department's new priorities and roles visit the DH website.
Formerly established as the NHS Commissioning Board in October 2012, NHS England is an independent body, at arm's length to the Government. Its main role is to improve health outcomes for people in England and:
- Provide national leadership for improving outcomes and driving up the quality of care
- Oversee the operation of clinical commissioning groups
- Allocate resources to clinical commissioning groups
- Commission primary care and specialist services
For more information visit NHS England.
Clinical commissioning groups (CCGs)
Primary care trusts (PCTs) were responsible for commissioning most NHS services and controlled 80% of the NHS budget.
On April 1 2013, PCTs were abolished and replaced with clinical commissioning groups (CCGs). CCGs have taken on many of the functions of PCTs and in addition some functions previously undertaken by the Department of Health. Birmingham CrossCity CCG is a Clinical Commissioning Group.
CCGs are made up of member GP practices, as well as other health professionals, such as nurses. They commission most health services, including:
- Planned hospital care
- Rehabilitative care
- Urgent and emergency care (including out-of-hours)
- Most community health services
- Mental health and learning disability services
CCGs can commission any service provider that meets NHS standards and costs. These can be NHS hospitals, social enterprises, charities, or private sector providers. However, they must be assured of the quality of the services they commission, taking into account both National Institute for Health and Care Excellence (NICE) guidelines and the Care Quality Commission's (CQC) data about service providers.
Both NHS England and CCGs have a duty to involve their patients, carers and the public in decisions about the services they commission.
Health and wellbeing boards
Every ‘upper tier' local authority is establishing a health and wellbeing board to act as a forum for local commissioners across the NHS, social care, public health and other services. The boards help to:
- Increase democratic input into strategic decisions about health and wellbeing services
- Strengthen working relationships between health and social care
- Encourage integrated commissioning of health and social care services
For more information read the DH guide on Health and wellbeing boards.
Public Health England
This is a new organisation which will provide national leadership and expert services to support public health and will also work with local government and the NHS to respond to emergencies. Public Health England (PHE) will:
- Co-ordinate a national public health service and deliver some elements of this
- Build an evidence base to support local public health services
- Support the public to make healthier choices
- Provide leadership to the public health delivery system
- Support the development of the public health workforce
Regulation – safeguarding people's interests
Since April 2013, some elements of the regulation system have changed. Responsibility for regulating particular aspects of care is shared across a number of different bodies, such as:
- Care Quality Commission
- Individual professional regulatory bodies, such as the General Medical Council, Nursing and Midwifery Council, General Dental Council and the Health and Care Professions Council
- Other regulatory, audit and inspection bodies – some of which are related to healthcare and some specific to the NHS
For more information about individual regulators, visit Health watchdogs and authorities.
Care Quality Commission
The Care Quality Commission (CQC) continues to regulate all health and adult social care services in England, including those provided by the NHS, local authorities, private companies and voluntary organisations.
Read more about the CQC.
Monitor has expanded its role to regulate all providers of health and adult social care services. Monitor aims to promote competition, regulate prices and ensure the continuity of services for NHS foundation trusts.
Under the new system, most NHS providers will need to be registered with both the CQC and Monitor to be able to legally provide services.
Note: all service providers are required to hold a licence issued jointly by the CQC and Monitor. To get a licence, providers will need to meet essential standards of quality and safety. They'll also have to follow certain behaviours relating to price setting, integrated care and competition. More importantly, providers will have to ensure services don't stop in the event of financial difficulties. If a provider does not fulfil the terms and conditions of the licence, both Monitor and CQC can take independent action, such as issuing warning notices or financial penalties.
Find out more about Monitor.
Healthwatch is a new organisation and functions as an independent consumer champion, gathering and representing the views of the public on health and social care services in England.
It operates both at a national and local level and ensures the views of the public and people who use services are taken into account.
Locally, Healthwatch will give patients and communities a voice in decisions that affect them, reporting their views, experiences and concerns to Healthwatch England. Healthwatch England will work as part of the CQC.
Read more about Healthwatch England.
Other changes to the regulation system
Following the abolition of strategic health authorities (SHAs), the NHS Trust Development Authority (NHS TDA) will be responsible for overseeing the performance, management and governance of NHS Trusts, including clinical quality, and also managing their progress towards foundation trust status. The TDA has a range of powers, from appointing chairs and non-executive directors, to requiring a trust to seek external advice.
For more information visit the TDA website.