7: Organisation and management of the NHS

Question 1

when was NHS created?

Answer 1

Creation in 1948 as part of the welfare state

Question 2

what are the Three core principles of the NHS?

Answer 2

– universal (covering everyone)
– comprehensive (covering all health needs)
– free at the point of delivery – available to all based on need not ability to pay

Question 3

Duty of secretary of state for health?

Answer 3

to provide health services

Question 4

NHS initially run centrally by whom?

Answer 4

Department of Health

Question 5

what is increasing within the NHS?

Answer 5

• Increasing role for managers (More strategic management roles)
• Increasing marketisation of provision

Question 6

what are the increasing marketisation of provision?

Answer 6

– Competition between hospitals: aimed at improving choice and quality, containing costs
– Separation of ‘commissioners’ and ‘providers’ of care

Question 7

what is commissioning within the NHS?

Answer 7

– 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

Question 8

what is the health and social care act of 2012?

Answer 8

– 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)

Question 9

what does devolution of NHS mean?

Answer 9

Scotland, Wales and Northern Ireland each have a differently organised NHS

Question 10

who has Overall accountability for NHS?

Answer 10

Secretary of State for Health

Question 11

function of department of health?

Answer 11

– 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)

Question 12

function of NHS england?

Answer 12

– Authorises Clinical Commissioning Groups
– Supports, develops and performance-manages
commissioning
– Commissions specialist services, primary care, and some others

Question 13

clinical commissioning groups function? (CCG)

Answer 13

• 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%)

Question 14

who commissions general primary care services?

Answer 14

NHS england

Question 15

what is public health now the responsibility of?

Answer 15

local authorities

Question 16

what do CCGs and NHS England commission providers provide?

Answer 16

• provide care for the populations they serve
– NHS acute trusts (hospitals) for much acute care
– Community healthcare trusts
– Other providers, including the private sector

Question 17

where does money to NHS trusts come from?

Answer 17

• from CCGs and NHS England, through commissioning process

* Commissioners can place contracts with private/voluntary sector providers too

Question 18

where do NHS trusts earn most income through?

Answer 18

• 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

Question 19

other organisations involved?

Answer 19

• 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

Question 20

NHS future questions?

Answer 20

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?