NHS structure Wellard's NHS training wellards.co.uk June 2007

1. NHS structure Wellard's NHS training wellards.co.uk June 2007

2. Introduction • The NHS: • Employs well over a million staff • Is spending £87.2bn across the UK in 2005/06

3. Devolution Each country in the UK has direct control over its own health service UK health spending per capita is lowest in England because of economies of scale

4. NHS Wales

5. NHS Scotland

6. NHS Northern Ireland

7. NHS England

8. The Department of Health Parliamentary Under Secretary of State for Care ServicesIvan Lewis Minister of State for Delivery and Quality Andy Burnham Minister of State for Quality Lord Hunt of King's Heath Minister of State for Health Services Rosie Winterton Secretary of State for Health Alan Johnson Minister of State for Public Health Caroline Flint

9. The Department of Health • DH responsibilities • The NHS • Public health • Social care • DH concentrates on: • setting direction • national standards • securing resources • major investment decisions • choice for patients and users

10. DH agencies Department of Health Non-governmental bodies Special health authorities

11. NHS boards and management • Trust board meeting agenda • Devise local strategy • Agree work programme • Monitoring progress and evaluate results • Assure quality of services • Ensure best use of financial resources • Attendees • Lay chairman • Five non-executive directors • Up to five executive directors Day-to-day running of a PCT left to the PEC

12. Strategic health authorities • To do • Manage the performance of the local NHS • Link the DH and the NHS • Ensuring primary care trusts (PCTs) and NHS trusts make adequate plans and for consolidating these into a local delivery plan (LDP) • Monitor the performance of NHS trusts and PCTs against the LDPs There are 10 SHAs in England

13. NHS trusts • Key facts • Obtain their revenue through service agreements with PCTs • Statutory duties: • ensure high quality of care • break even • Must work with other local health and social care organisations • Large and complex organisations overseeing local services in one or more hospital There are about 250 NHS trusts in England

14. Hospital services • Secondary care services are provided by: • District general hospitals (DGHs) • Offer outpatient, inpatient treatment and surgeryTypically serve a population of 200,000-300,000 • Medium-sized hospitals • Linked to DGHs as they do not provide full emergency servicesMay serve a population of about 100,000 • Specialist tertiary centres • Offer specialised services for complex conditions and treatmentsMake up a small proportion of overall hospital services • Community hospitals • Offer minor injury, rehabilitation, palliative and respite careUsually run by PCTs

15. Foundation trusts There are 67 foundation trusts in England Inspected by Monitor • Privileges for foundation trusts • More freedom to run services • Retain proceeds from land sales to invest in patient services • Make own investment decisions • Use flexibilities in the revised NHS pay system to modernise the workforce

16. Treatment centres • 44 NHS treatment centres in England (two more on the way) • 14 independent sector schemes Increase the number of planned surgical operations performed Separate elective tests and surgery from emergency work to improve productivity Centres provide scheduled diagnostic and treatment services Run by the NHS or commissioned by PCTs from private sector

17. Primary care trusts Board accountable to DH • PCTs in England • improve the health of local people • develop primary and community health services • commission hospital services Overseen by SHAs GPs take on commissioning role with PBC

18. Practice-based commissioning • PBC has not taken off as fast as originally thought • Interest is significant but take up is slow: • PCTs reluctant to hand over control • PCTs find it hard to calculate budgets and management costs • Lack of timely data —GPs need to track patients and budgets • Has a long-term future because PCTs cannot manage demand

19. Payment by results April 2004 — PbR was first introduced for foundation trusts It is being phased in for other NHS acute trusts, with target of 90 per cent of hospital care covered by 2008/09 January 2005 — decision made to modify the scope of PbR payments so that they would only apply in 2005/06 to elective care PbR for emergency and outpatient care was deferred for a year March 2006 — new tariff published Possible there may be further modifications to prevent enthusiastic hospitals from undermining the drive to provide as much care as possible outside hospitals Despite this change the Department of Health says the overall timetable remains the same, with the target date still 2008/09

20. The primary & social care White Paper • Our health, our care, our say: a new direction for community services pushes the out-of-hospital care agenda. • It was published in February 2006. • It covers • new generation of community hospitals • self-referral to practitioners other than GPs • increased access to GPs • patient information for those with long-term conditions

21. Final comments