England UNDERSTANDING THE NEW NHS A guide for everyone working and training within the NHS 2 Contents 3 NHS ENGLAND INFORMATION READER BOX Introduction 4 Directorate ◆ The NHS belongs to us all Medical Operations Patients and information Nursing Policy Commissioning development Foreword (Sir Bruce Keogh) 5 Finance Human resources NHS values 6 Publications Gateway Reference: 01486 ◆ NHS values and the NHS Constitution Document purpose Resources ◆ An overview of the Health and Social Care Act 2012 Document name Understanding The New NHS Structure of the NHS in England 8 Author NHS England ◆ The structure of the NHS in England Publication date 26 June 2014 ◆ Finance in the NHS: your questions answered Target audience Running the NHS 12 ◆ Commissioning in the NHS Additional circulation Clinicians working and training within the NHS, allied ◆ Delivering NHS services list health professionals, GPs ◆ Health and wellbeing in the NHS Description An updated guide on the structure and function of Monitoring the NHS 17 the NHS, taking into account the changes of the Health and Social Care Act 2012 ◆ Lessons learned and taking responsibility ◆ Regulation and monitoring in the NHS Action required None Contact details for Dr Felicity Taylor Working in the NHS 20 further information National Medical Director's Clinical ◆ Better training, better care Fellow, Medical Directorate Skipton House NHS leadership 21 80 London Road SE1 6LH ◆ Leading healthcare excellence www.england.nhs.uk/nhsguide/ Quality and innovation in the NHS 22 ◆ High-quality care for all Document status This is a controlled document. While this document may be printed, the The NHS in the United Kingdom 24 electronic version posted on the intranet is the controlled copy. Any printed copies of this document are not controlled. As a controlled document, this ◆ The NHS in Scotland, Wales, Northern Ireland document should not be saved onto local or network drives but should always be accessed from the intranet. Glossary 26 Understanding The New NHS 4 Introduction Foreword 5 Clinical was a collaborative process; it was not The NHS belongs to us all professionals the role of one person alone. Change in training are only happens when clinicians, fundamental managers, policy makers, and all This guide is for everyone working and training within the NHS*. Together we to the success sorts of people who are expert in the are the guardians of the NHS and it is us who will help to steer the NHS through of the NHS; different aspects of healthcare have the clinical and economic challenges of the next generation. These challenges whether a nurse, the will to work together to achieve are unprecedented in the history of the NHS: rising costs unmatched by funding, scientist, doctor, the same goal or vision. an ageing population with multiple chronic conditions, and a system that is not or allied health Young, enthusiastic clinicians can add currently structured to meet modern standards of quality of care that surpass professional, it is you who will provide significant insight into our biggest patients' expectations. the insight and solutions to the many healthcare challenges, but unless you challenges that the NHS faces. know how to channel this enthusiasm For most healthcare professionals, training is focused solely on the provision of As a medical student and a junior and how the system works, nothing will clinical care. Yet, for every interaction with a patient (and NHS staff have contact doctor I personally gave little thought happen. I had to learn by experience, with more than 1.5 million patients and their families every day) there is a vital to how the NHS worked – I was busy but if I had understood the system system of purchasing and planning, financing, and regulatory activity required learning or looking after patients, properly from the beginning, I would to support it. and I felt that 'management' was have avoided a great deal of trial and someone else's responsibility. Over error, as well as frustration. This is why I To truly effect change and improve the quality of care for our patients, we need the years I began to appreciate that want you to have this guide. to go beyond our clinical training, and learn to understand and engage with the this perception was misguided. If I I know that clinical trainees have organisations, systems and processes that define, sustain and regulate the NHS. really cared about how well patients sometimes felt at the mercy of This is no easy task; the NHS is an increasingly complex system, and finding your were treated then I had a moral 'management' or 'policy'. Let's change way through the maze can be confusing. and professional responsibility to that. Instead I invite you to be part understand the system in which I of it. By all means use this guide for In reading this guide, we hope that the structures of the NHS, and your place practised. general interest, to answer interview within it, become a little clearer. With understanding comes the confidence to I know that many trainees feel questions, to understand policies, engage with and challenge the system, helping to improve our NHS for patients undervalued and disenfranchised buzzwords and 'management speak'. and staff, now and in future generations by the organisations in which they Use it to immerse yourself in the work. This feeling discourages them system in which you work. But more * This guide mainly refers to the NHS in England, but we hope it will be of use to from engaging enthusiastically importantly, I hope that you will also colleagues in other countries. with others to change the way NHS use it to empower yourself and your organisations deliver services. This is colleagues to get to know how the Dr Felicity Taylor a huge loss, given that our trainees in NHS works and to really make it your Dr Salman Gauher all professions not only have a unique own. You are an integral part of the insight into how things really work, but NHS system and you are tomorrow's Dr Leann Johnson also have the most innovative ideas for clinical leaders. Dr Rachael Brock how the NHS could be improved for the Dr Marc Wittenberg benefit of staff and patients alike. NHS England National Medical Director's Clinical Fellows 2013/14 I want our trainees to play a central role in improving the NHS. Throughout my career I wanted to improve things. I could see some of the problems, but I didn't know how to go about making Professor Sir Bruce Keogh KBE, MD, changes within the system. Over time I DSc, FRCS, FRCP realised that making real improvement National Medical Director Understanding The New NHS Understanding The New NHS 6 NHS values NHS values 7 An overview of the Health Working together for patients and Social Care Act 2012 Patients come first in everything we do. We fully involve patients, staff, families, carers, The Health and Social Care Act 2012 nation's health and to address communities, and professionals inside introduced radical changes to the health inequalities. and outside the NHS. way that the NHS in England is Everyone counts We speak up when Compassion We maximise our things go wrong. We ensure that compassion organised. The legislative changes D. A streamlining of 'arms-length' resources for the benefit is central to the care we of the whole community, provide and respond with from the Act came into being on bodies. The Act conferred additional and make sure nobody is humanity and kindness to responsibility on the National Institute excluded, discriminated each person’s pain, distress, 1 April 2013 and include: against or left behind. anxiety or need. for Health and Care Excellence (NICE A. A move to clinically led – formerly the National Institute commissioning. Planning and for Clinical Excellence) to develop NHS purchasing healthcare services for guidance and set quality standards local populations had previously been for social care. The Health and Social Commitment to performed by England's 152 primary Care Information Centre (HSCIC) was Improving lives VALUES quality of care We strive to improve We earn the trust placed care trusts (PCTs). The Act replaced the also tasked with responsibility for health and wellbeing in us by insisting on and people’s experiences quality and striving to get PCTs with 211 clinical commissioning collecting, analysing and presenting of the NHS. the basics of quality of groups (CCGs), led by clinicians. CCGs national health and social care data. Respect and dignity care – safety, effectiveness and patient experience – now control the majority of the NHS We value every person right every time. – whether patient, their budget, with highly specialist services E. Allowing healthcare market families or carers, or competition in the best interest of staff – as an individual, and primary care being commissioned respect their aspirations by NHS England. patients. The Act aimed to allow and commitments in life, and seek to understand fair competition for NHS funding to their priorities, needs, abilities and limits. B. An increase in patient involvement independent, charity and third-sector in the NHS. The Act established healthcare providers, in order to give independent consumer champion greater choice and control to patients organisations locally (Healthwatch) in choosing their care. To protect and nationally (Healthwatch the interests of patients under these England) to drive patient and public new arrangements, Monitor was involvement across health and social established as the sector regulator for NHS values and the Constitution care in England. The Healthwatch health services in England. Monitor network has significant statutory issues licences to NHS-funded providers, The NHS values describe what we NHS to explicitly set out what patients, powers to ensure the voice of the has responsibility for national pricing aspire to in providing NHS services, to the public and staff can expect from the consumer is strengthened and heard and tariff (in conjunction with NHS facilitate co-operative working at all NHS and what the NHS expects from by those who commission, deliver and England) and helps commissioners levels of the NHS.