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Guide to the Healthcare System in England Including the Statement of NHS Accountability

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Guide to the Healthcare System in England Including the Statement of NHS Accountability Guide to the Healthcare System in England Including the Statement of NHS Accountability for England May 2013 Contents | 1 Contents Introduction: What is the NHS? 2 Providing care 4 Commissioning care 6 Safeguarding patients 12 Empowering patients and local communities 17 Education and training 20 Supporting providers of care 22 The Secretary of State for Health 25 Statement of NHS Accountability 28 2 | Guide to the Healthcare System in England Introduction: What is the NHS? “The NHS belongs to the people. It provides a comprehensive service, available to all irrespective of gender, race, disability, age, sexual orientation, religion or belief, gender reassignment, pregnancy and maternity, or marital or civil partnership status”. NHS Constitution The NHS began in 1948 out of a Others, such as charities providing NHS principle that good healthcare should funded services, play a key role in be available to all, with access based on making the NHS what it is, yet are not clinical need, not ability to pay. NHS organisations themselves. That principle, of putting patients first, remains at its core. NHS services are Collectively, all of these organisations free of charge to patients in England, make up the healthcare system. This except where permitted by Parliament. guide seeks to explain that system. The service’s original focus was the The main audience for this document is diagnosis and treatment of disease. people who are interested in gaining an Now it plays an increasing role in both understanding of how the whole preventing ill health and improving the healthcare system works. The term physical and mental health of the ‘stakeholder’ is used throughout this population. document to describe the people who have an interest in the NHS. If you have The rights to which patients, families, any comments on or questions about carers, the public and staff are entitled, this document, please email and the pledges that the NHS is [email protected]. committed to achieve, are now set The Department plans to update it out in the NHS Constitution. Visit annually, or following any significant http://www.nhs.uk/Constitution to developments to the health and view the NHS Constitution. It articulates care system. the shared values of the NHS, and the responsibilities towards the NHS that The guide concludes with a Statement patients, families, carers, the public and of NHS Accountability; keeping an up staff have as they experience or work in to date version of the Statement is a NHS services. commitment set out in principle seven of the NHS Constitution. A number of different organisations make up and support the set of Figure 1 shows the main organisations common set of principles and values that make up the healthcare system in which are the NHS. Some of these are England. Visit https://www.gov.uk/ NHS organisations as set out in law, government/organisations#department- such as clinical commissioning groups. of-health for definitions and web addresses for all the organisations. Introduction: What is the NHS? | 3 Fig. 1 The healthcare system in England from April 2013 MENT OF RT H A E P A E LT D H The health & care system Care Quality Commission from April 2013 Human Healthwatch Fertilisation NHS England & Embryology Litigation Human Authority Authority Tissue Authority Local Healthwatch NHS Blood & Transplant Health Research Online/phone Community Authority NHS National services groups Institute for O England Clinical Health Research T GP Commissioning H NIHR Clinical surgeries Groups Research Networks E R Ambulances OM C M & U G E N L I P T O O I E E S Monitor P V E Care homes R T Hospitals N N NHS Trust M E Development Health & Social Authority E M Care Information N A Centre I T L Personal Health D R helpers centres E A NHS Business P P Services A Authority R T M Home Pharmacies Local Education & Training E S N KEY E Boards Health C T I V Education Dentists R S Public Health E S England Providing care Local Opticians E S R England A D Government C R A & LTH O HEA B LOCAL G Commissioning care EIN B ELL HEALTH & W Improving public health Professional National Institute regulators S for Health & ION Empowering people and SAT Care Excellence I L RGAN OCAL O local communities Medicines & Healthcare Products S Regulatory Agency ON Supporting the health and SATI NI NATIONAL ORGA care system Education and training ING D UAR FEG & SA REGULATION Safeguarding patients’ E SECRETARY OF STAT interests 4 | Guide to the Healthcare System in England Providing care The NHS is made up of a wide range requires more specialised treatment, or of organisations specialising in different further investigation, patients may be types of services for patients. Together, referred to another healthcare provider. these services deal with over 1 million These could be based in a hospital, or patients every 36 hours. in the community. Patients are entitled (where possible) to choose between Providers of ‘primary care’ are the first different types of care and providers of point of contact for physical and their care. They should be supported to mental health and wellbeing concerns, make the choice that is best for them2. in non-urgent cases. These include general practitioners (GPs), but also Community based care is increasingly dentists, opticians, and pharmacists the preferred means of providing care (for medicines and medical advice). for the majority of longer term and There are over 36,000 GPs in England, mild to moderate conditions. This working in over 8,300 practices1. enables people to keep their normal For urgent cases, patients can visit a routine, staying close to family and provider of urgent care, such as an friends. Hospital services remain a key accident and emergency department. part of the NHS, such as for Healthcare information and advice can specialised, surgical or emergency care. also be accessed through NHS Choices (www.nhs.uk). Organisations that put patients first, by meeting NHS quality and financial Health care professionals within GP standards, are able to provide NHS practices aim to resolve problems funded services. Quality is the locally, including through services overriding priority for the healthcare provided by the practice. If a condition 2 For more detail on choice please see the 1 Source: www.indicators.ic.nhs.uk, GP Practice Handbook to the NHS Constitution or NHS Data, 2010 Choices on www.nhs.uk Providing care | 5 system; improving quality is the hospitals often belong to a single trust. responsibility of everyone working in In NHS foundation trusts, the board of the NHS. In healthcare, quality is a directors is directly accountable to their combination of good medical local population through their outcomes (supported by evidence), membership and council of governors. safe care and good patient experience. The public, patients, service users, their families and carers, and staff can join NHS funded services include both NHS their local foundation trust as provider organisations, and other members. Members elect governors providers of health services such as to represent them. In a foundation charities, private organisations, and trust, the council of governors oversees social enterprises. This document uses the organisation’s board, holding the the term ‘provider’ to refer to all types board to account for the performance of organisations that provide NHS of their organisation. funded care. All providers are led by a board of directors (or equivalent3), who have ultimate responsibility for the quality of care and for the ongoing financial stability of their organisation. The majority of NHS services, such as hospitals, belong to either an NHS trust or NHS foundation trust. It is the Government’s ambition that all NHS trusts will ultimately become NHS foundation trusts. Each trust can have multiple sites, meaning one or more What is an ‘outcome’? Rather than measure healthcare processes, for example – the number of hip replacements performed – it is better to ask patients whether their hip replacement was effective. This measures how good hip replacements are from a patient perspective. By using this measure, providers of hip replacements should focus on providing a good hip replacement service to patients, as opposed to focusing mainly on the number of operations completed. 3 Not all provider organisations will have a board as such, for example, GP practices are unlikely to have boards. Every organisation will have a person or people who are legally accountable for the service they are providing, and for simplicity, the term board will be used throughout this document. 6 | Guide to the Healthcare System in England Commissioning care Commissioning of NHS services that referral. This ‘secondary’ provider The NHS is funded by taxation with a is paid to treat the patient through the fixed budget available to spend on NHS payment system. What care the services for the whole population. GP can buy for their patient is The challenge faced by the NHS is how determined by the commissioning to spend that budget in a way that organisation. results in the best possible outcomes for individual patients and delivers Because of the complexity and scale value for money for the public. This of the healthcare system, it is more planning and purchasing of NHS efficient to plan and commission services is undertaken by organisations healthcare at a population level, such (or individuals) known as as a town and its surroundings or a commissioners. They are responsible metropolitan borough. All GP practices for assessing the reasonable needs of are required to be a member of a their populations and using their clinical commissioning group (CCG). buying power as purchasers to secure CCGs provide the organisational services that are affordable and of the infrastructure to enable GPs, working highest quality.
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