NHS Flashcards
Integrated Care Systems overview
Integrated care systems (ICSs) are partnerships of organisations that come together to plan and deliver joined up health and care services, and to improve the lives of people who live and work in their area.
Following several years of locally led development, recommendations of NHS England and passage of the Health and Care Act (2022), 42 ICSs were established across England on a statutory basis on 1 July 2022.
Replaced CCGs
Funded by NHS England
ICS breakdown
Integrated care partnership (ICP)
A statutory committee jointly formed between the NHS integrated care board and all upper-tier local authorities that fall within the ICS area. The ICP will bring together a broad alliance of partners concerned with improving the care, health and wellbeing of the population, with membership determined locally. The ICP is responsible for producing an integrated care strategy on how to meet the health and wellbeing needs of the population in the ICS area.
Integrated care board (ICB)
A statutory NHS organisation responsible for developing a plan for meeting the health needs of the population, managing the NHS budget and arranging for the provision of health services in the ICS area. The establishment of ICBs resulted in clinical commissioning groups (CCGs) being closed down.
ICS issues
GPOnline survey showed a third thought it wouldn’t improve patient care
Around 9,000 roles will be removed during the restructuring of NHS England’s workforce, but some staff members will not know their fate until March 2024, the organisation has admitted.
Parliament’s public accounts committee, which scrutinises public spending, said it was unclear what “tangible benefits” the overhaul would bring for patients and identified “a worrying lack of oversight” over how the new arrangements would work.
The MPs said the huge problems confronting the NHS — including a record backlog of non-emergency treatment, gaping staff shortages in both health and social care, increasing demand and limits on funding — mean ICS may founder.
Primary/Secondary/Tertiary health care
primary care, secondary care, and tertiary care. Primary care is often the first point of contact for people in need of healthcare, usually provided by professionals such as GPs, dentists and pharmacists.
Secondary care, which is sometimes referred to as ‘hospital and community care’, can either be planned (elective) care such as a cataract operation, or urgent and emergency care such as treatment for a fracture. Tertiary care refers to highly specialised treatment such as neurosurgery, transplants and secure forensic mental health services.
Providers
210 NHS providers of secondary and tertiary care – 143 foundation trusts and 67 NHS trusts. Other non-NHS organisations such as charities and private healthcare companies also provide secondary and tertiary care services.
Of the 210 NHS providers there are:
72 acute providers (providing largely hospital-based services)
10 ambulance services
14 community providers (providing services such as district nursing, health visiting)
49 integrated providers (for example organisations that provide both acute and community care)
20 mental health providers
30 combined mental health and learning disability and community providers
15 specialist providers (providing services such as specialist eyecare or cancer treatment).
Gov body responsible for NHS
Department for Health and Social Care
NHS England
NHS England, officially the NHS Commissioning Board, is an executive non-departmental public body of the Department of Health and Social Care.
It oversees the budget, planning, delivery and day-to-day operation of the commissioning side of the National Health Service. It directly commissions NHS general practitioners, dentists, optometrists and some specialist services and funds ICS’s:
Through our seven integrated regional teams, NHS England supports local integrated care systems (ICS), made up of public services that provide health and care – NHS organisations, primary care professionals, local councils, social care providers and the community, voluntary and social enterprise sector
Commissioners v providers
In England there is an internal market where commissioners plan and purchase healthcare from the providers.
Commissioning is the process of assessing needs, planning and prioritising, purchasing and monitoring health services, to get the best health outcomes.
Services are commissioned by integrated care boards and are overseen by NHS England on a regional basis.
Main providers are GPs, dentists, NHS trusts, foundation trusts. Services may be purchased from “any qualified provider” and not solely NHS providers. This has been used by opponents to suggest the NHS is being privatised.
DHSC role and responsibilities
proposing legislation and national policy;
providing strategic leadership;
negotiating and distributing funds to NHS England;
ultimately answering to parliament for the performance of the NHS.
NICE
NICE advises on drugs and procedures that are both clinically and cost effective and should be provided on the NHS.
An executive non-departmental public body of the DHSC that publishes guidelines in four areas:
the use of health technologies within the NHS (such as the use of new and existing medicines, treatments and procedures)
clinical practice (guidance on the appropriate treatment and care of people with specific diseases and conditions)
guidance for public sector workers on health promotion and ill-health avoidance
guidance for social care services and users.
NICE was established in an attempt to end the so-called postcode lottery of healthcare in England and Wales, where availability of treatments depended on the NHS Health Authority area in which the patient happened to live, but it has since acquired a high reputation internationally as a role model for the development of clinical guidelines. One aspect of this is the explicit determination of cost–benefit boundaries for certain technologies that it assesses.
CQC
CQC is an executive non-departmental public body of the DHSC that sets standards of health care that should be provided and licenses and inspects all providers (including the private sector). Providers deemed to be inadequate may be put into special measures and ultimately closed down.
Part of the commission’s remit is protecting the interests of people whose rights have been restricted under the Mental Health Act.
Issues:
In September 2019 the Barking, Havering and Redbridge University Hospitals Trust stated their inspection by the CQC had become drawn out “due to availability of inspectors”.
In October 2019 State of Care report stated that 44% of A&E departments were rated as requiring improvement and 8% were rated as being inadequate. 36% of NHS Hospitals were given ratings of requiring improvement on safety with 3% considered inadequate in that area. Over the previous five years the 18-week waiting list for planned hospital treatment had increased from involving 3 mn patients to 4.4 mn.
In October 2020 the Department of Health asked the CQC to investigate the use of Do Not Resuscitate decisions early in the COVID-19 pandemic, when blanket DNACPR decisions were applied to all care home residents without considering individual circumstances.
Health and Wellbeing Boards
Health and wellbeing boards (HWBs) – a formal statutory committee of the local authority – have been a key mechanism for driving joined up working at a local level since they were established in 2013.
The Health and Care Act 2022 introduced new architecture to the health and care system, specifically the establishment of integrated care boards (ICBs) and integrated care partnerships (ICPs).
In this new landscape, HWBs continue to play an important statutory role in instilling mechanisms for joint working across health and care organisations and setting strategic direction to improve the health and wellbeing of people locally.
NHS Trust
An NHS Trust is a legal entity providing goods and services for the purposes of the health service. Serves either a geographical area or a specialised function (such as an ambulance service). Each trust is headed by a board consisting of executive and non-executive directors, and is chaired by a non-executive director.
NHS Issues
Issues may include: too many managers; lack of funds; population and demographic changes (growing population and increasing number of elderly); health inflation (new drugs and procedures); healthcare by postcode; NICE and unwillingness to provide costly cancer drugs; internal market (including the private sector – PFIs); possible closure of hospitals / units; A & E close to collapse; seven-day NHS; shortage of doctors / nurses; doctors’ contracts; new inspection regime; poor links with local authority community care.
National Institute for Health Protection
New organisation to focus on rigorous science-led approach to public health protection
Institute will boost UK’s ability to deal with and recover from COVID-19 and meet health challenges of the coming winter
