7: Organisation and management of the NHS Flashcards
when was NHS created?
Creation in 1948 as part of the welfare state
what are the Three core principles of the NHS?
– universal (covering everyone)
– comprehensive (covering all health needs)
– free at the point of delivery – available to all based on need not ability to pay
Duty of secretary of state for health?
to provide health services
NHS initially run centrally by whom?
Department of Health
what is increasing within the NHS?
- Increasing role for managers (More strategic management roles)
- Increasing marketisation of provision
what are the increasing marketisation of provision?
– Competition between hospitals: aimed at improving choice and quality, containing costs
– Separation of ‘commissioners’ and ‘providers’ of care
what is commissioning within the NHS?
– A key part of markets: commissioners act as ‘customers’, choosing between different care providers on patients’ behalf
– Commissioners choose on the basis of patients’ needs, cost, quality
what is the health and social care act of 2012?
– Devolves power (especially commissioning) to GPs and
others in primary care
– Increases use of markets, with opportunities for NHS staff to set up their own care organisations (‘social enterprises’)
– requires efficiency savings of £20bn per annum (on a budget of c.£100bn)
what does devolution of NHS mean?
Scotland, Wales and Northern Ireland each have a differently organised NHS
who has Overall accountability for NHS?
Secretary of State for Health
function of department of health?
– Sets national standards
– Shapes direction of NHS and social care services
– Sets ‘national tariff’ (fee for services charged by service providers, e.g. hospital trusts, to commissioners, i.e. CCGs)
function of NHS england?
– Authorises Clinical Commissioning Groups
– Supports, develops and performance-manages
commissioning
– Commissions specialist services, primary care, and some others
clinical commissioning groups function? (CCG)
• Crucial in new organisation of the NHS:
– Bring together healthcare services
– account for national guidance (from NHS England, NICE etc.) in decisions
• Responsible for the flow of much of the NHS budget
(around 65%)
who commissions general primary care services?
NHS england
what is public health now the responsibility of?
local authorities
what do CCGs and NHS England commission providers provide?
• provide care for the populations they serve
– NHS acute trusts (hospitals) for much acute care
– Community healthcare trusts
– Other providers, including the private sector
where does money to NHS trusts come from?
- from CCGs and NHS England, through commissioning process
* Commissioners can place contracts with private/voluntary sector providers too
where do NHS trusts earn most income through?
• the services that CCGs and NHS England commission from them
• get income from the provision of undergraduate and postgraduate training
• High-performing trusts can earn greater financial and
managerial autonomy by gaining foundation trust (FT)
status
other organisations involved?
- Monitor: regulates financial of NHS Trusts
- Care Quality Commission (CQC): quality of care to NHS patients
- NICE: commissioning guidance to CCGs and quality standards to providers
- Commissioning Support Units: assist with commissioning decisions (for CCG)
- Healthwatch: national and local bodies to facilitate patient and public involvement
- Public Health England: coordination and leadership for public health
- Health and Wellbeing Boards: healthcare, social care and public health between CCGs and local authorities
- Clinical senates: offer CCGs advice from hospital specialists and others
NHS future questions?
Change is ongoing and will continue:
• Pressures are perennial: ageing population; shifting
burden of disease; new technologies; increasing
expectations; financial austerity
• How far can NHS continue to serve its original mission?
• What are implications of involving the private sector, for
better and worse?
• Are GPs and colleagues in primary care the right people
to make commissioning decisions?
• Will patients really be empowered?
