Nhs

Question 1

When was the Ministry of health and NHS created?

Answer 1

1919 ministry of health
1948 national health service (NHS)

Question 2

What are the three principles that Aneurin bevan set on 1948 when the NHS was launched

Answer 2

That it meets the needs of everyone

That would be free at the point of delivery

That it be based on Clinical need not ability to pay

Question 3

How many people are employed in the NHS?

Answer 3

NHSUK employees 1,.5 million people

NHS Scotland employees 156,178 people

NHS Wales employs 98,000

NHS Northern Ireland employees 64,688 people

Question 4

What are the problems of the NHS is facing?

Answer 4

“ the most immediate challenge is managing the increased demand on the healthcare system”. More people are being seen more quickly than any point in history.

An aging population

Arise in long-term conditions

Advances in treatment discoveries of new drugs

Higher a patient expectations

Recovery from COVID-19 pandemic

Question 5

Explain how the health and care act of 2022 led to the formation of ICS and what are icb and icp

Answer 5

1. Integrated Care Systems (ICSs):
   • Definition: Partnerships that unite NHS organizations, local authorities, and other stakeholders to collectively plan and deliver health and care services within a specific geographical area.
   • Responsibilities:
   • Enhance population health and healthcare.
   • Address unequal health outcomes and access.
   • Boost productivity and value for money.
   • Support broader social and economic development.
2. Integrated Care Boards (ICBs):
   • Definition: Statutory entities within each ICS responsible for the strategic planning and allocation of NHS resources in their area.
   • Responsibilities:
   • Develop a plan to address the health needs of the population.
   • Allocate resources to deliver NHS services.
   • Oversee the integration of health services with local authorities and other partners.
3. Integrated Care Partnerships (ICPs):
   • Definition: Collaborative committees that bring together ICBs and local authorities, along with other partners like the voluntary sector, to focus on health and social care integration.
   • Responsibilities:
   • Develop an integrated care strategy addressing the health and social care needs of the population.
   • Promote collaboration among health, social care, public health, and other services.

Geographical Levels of Operation:

System Level:
• Scope: Covers the entire ICS region, which can range from 500,000 to over 3 million people.
• Responsibilities: Strategic oversight, resource allocation, and ensuring consistency across the region.

Place Level:
• Scope: Typically aligns with local authority boundaries within the ICS.
• Responsibilities: Design and delivery of services tailored to local communities, addressing specific health needs and priorities.

Neighborhood Level:
• Scope: Smaller, community-focused areas within a ‘place,’ often serving populations of 30,000 to 50,000 people.
• Responsibilities: Direct delivery of services through primary care networks, focusing on personalized and preventive care.

This structure aims to foster collaboration across different sectors and ensure that care is tailored to the unique needs of communities at various levels.

Question 6

Explain the function and roles of NHS England (NHSE)

Answer 6

NHS England provide long-term plan and promote high-quality of healthcare. They are responsible for strategic oversight and direct commission of services such as the specialised services of neonatal rare cancers public services such as section 7 a services like immunisation and screening and armed forces and people in prison.

They are responsible for this through regional teams, including east of England, London Midlands north east Yorkshire Northwest south east Southwest

Question 7

What was established for Clinical commission groups to be closed down?

Answer 7

An integrated care board which is a statutory NHS organisation responsible for developing a plan for meeting health needs of a population and managing NHS budget arranging the provisions of healthcare services in the integrated care system area or what have now replaced Clinical commission groups

Question 8

Explain the key differences functions and roles of ICS, ICP and ICB

Answer 8

Definitions & Key Roles

In England’s NHS structure, Integrated Care Systems (ICSs) bring together health and care organisations to improve patient outcomes. They consist of three key components:
1. Integrated Care System (ICS)
• An overarching partnership of organisations working together to improve health and care for a specific population.
• Includes the NHS, local authorities, and voluntary/community sectors.
• Focuses on collaboration, prevention, and reducing health inequalities.
2. Integrated Care Board (ICB)
• A formal NHS body responsible for planning and commissioning healthcare services within an ICS.
• Controls NHS funding and ensures services meet national standards.
• Works with NHS providers, primary care, and local authorities.
• Key responsibilities include allocating resources, commissioning services, workforce planning, and monitoring performance.
3. Integrated Care Partnership (ICP)
• A collaboration between NHS, local councils, and other partners such as the voluntary sector.
• Focuses on wider determinants of health, such as housing, employment, and social care.
• Develops an Integrated Care Strategy to align with ICB plans.
• Provides strategic direction but does not directly manage NHS services.

Key Differences
• ICS refers to the overall system aiming to integrate health and care services across a region.
• ICB is the NHS decision-making body within the ICS, responsible for funding and service planning.
• ICP is a broad partnership that influences strategy but does not directly manage services.

Question 9

What are the key purposes of integrated care systems?

Answer 9

Improve outcomes in population health and healthcare

Improving the health of children and young people

Supporting people to stay well and independent

Tackle inequalities and outcomes experiences and access

Enhance productivity and value for money i’m getting the best from collective resources

Help NHS support broader social and economic development

Question 10

Explain the difference between primary care secondary care and tertiary care

Answer 10

Primary care is the first point of contact and is usually GP’s dentist pharmacist

Secondary care or hospital and community care is planned or elective surgery or treatment such as cataracts

Tertiary care refers to highly specialised treatment such as neurosurgery transplants and secure forensic mental health services

Question 11

Describe NHS providers on their numbers

Answer 11

There are 210 provider organisations

72 acute providers providing hospital based services

49 integrated providers organisations that provide both acute and community care

30 combined mental health and learning disability community providers

20 mental health providers

15 specialist providers, including specialist, I can cancer treatment

14 community providers providing services such as district nursing and health visiting

Question 12

How many integrated care systems were established across England on a statutory basis on the 1st of July 2022?

Answer 12

42 integrated care systems were established on a statutory basis on the 1st of July 2022

Question 13

As of 2021 public health England was replaced by which organisation

Answer 13

The UK health and security agency was founded on the 1st of October 2021 when it replaced public health, England

It is an executive agency responsible for controlling the impact of infectious diseases, chemical, be logically, radiological and nuclear incident and other health threats of every member of every community

UKHSA is sponsored by the department of health and social care

Question 14

What is a health and well-being board?

Answer 14

A formal statutory committee of local authorities that provide a form were political, clinical professional and community leaders from across the healthcare system together can improve the health and well-being of their local population and reduce inequalities

They do this to do the joint strategic needs assessment (JSNA) with the information gathered they publish a joint to local health and well-being strategy (GLHWS) which set out the priorities upon improving health and social well-being addressing the inequalities in the JSNA

Question 15

What are health and well-being boards (HWB)?

Answer 15

A formal statutory committee of local authorities that provide a form were political, clinical professional and community leaders from across the healthcare system together can improve the health and well-being of their local population and reduce inequalities

They do this to do the joint strategic needs assessment (JSNA) with the information gathered they publish a joint to local health and well-being strategy (GLHWS) which set out the priorities upon improving health and social well-being addressing the inequalities in the JSNA

Question 16

Describe independent two monitoring and regulation bodies

Answer 16

CQC or care quality commission is an independent regulator of health and social care. It’s responsible for monitoring inspecting and rating services and taking action to protect peoples who use the service speaking with independent voices and publishing review reviews.

Health watch England is an independent statutory body. They are over 150 local health organisations across the country. They are a champion of social care and receive feedback by patient and public on the use of GPs. They have the power to make NHS leaders and other decision makers listen to feedback and improve standards of care .

Question 17

What is the role of the national Institute of health and care excellence (NICE)?

Answer 17

Nice is responsible for encouraging uptake of best practice to improve outcomes for patients which is done through their review and guidance of new emerging technology efficacy studies, diagnostics, technologies and clinical research to promote effectiveness of specialise treatments and care

Nice also has a live of over 200 quality standards which set out priority areas for quality improvement. Nice indicators measure outcomes based on processes linked with evidence and reflect the quality of care.

Single indicator menu comprises of four types of indicators

Quality and outcomes framework or QOF

Clinical commission group indicators

National library quality indicators

General practice indicators outside of QOF

Question 18

What is the rule of NHS digital?

Answer 18

This is the digital data and delivery partner of the NHS and is responsible for running NHSUK and the NHS app as well as collecting disseminating data from national products for patients and clinics

Question 19

What is the role of health education England?

Answer 19

To ensure excellence and treatment by ensuring the workforce has the right Number skills values and behaviours at the right time of place

Question 20

What is the role of strategic clinical networks (SCN)?

Answer 20

To bring out improvement in priority service through

Reduction of unwarranted variation in the health and well-being services

Providing clinical advice for leadership to support decision-making whilst encouraging innovation

Question 21

What are Clinical Senate?

Answer 21

Clinical Senate help organisations who are planning and buying healthcare services to make the best decisions for people who use their services through offering guidance and advice

Question 22

What is an academic health science network (AHSN)?

Answer 22

They bring together NHS academic third sector local organisations there are 15 across England which are made to be small enough to be responsive but still connected

Their goal is to spread innovation by identifying areas of improvement in creating an innovation pipeline whilst empowering innovators to continue their train of thought and advancing the uptake on spread of innovation once it realises

Question 23

What are the three key planning documents in the NHS?

Answer 23

The NHS constitution which publishes and set out the principles and values the NHS

The NHS long-term plan which is published in 2019 and aim to have more joined and efficient. NHS reducing some of the demand on the system.

The NHS mandate which is published every year and set out the government objectives and a budget for the NHS England

Question 24

What are the sevenNHS principles?

Answer 24

One.the NHS provide provides comprehensive service available to all

2.access to the NHS is based on clinical need not ability to pay

ThreeNHS expires to the highest standards of excellent and professionalism

4.the patient will be at the heart of everything the NHS does

5.the NHS works across organisational boundaries

6.the NHS is committed to providing best value for taxpayers money

7.the NHS is accountable to the public communities and patient that it serves

Question 25

What are the 6NHS values?

Answer 25

Working together for patients Respect and dignity Commitment to quality of care Compassion Improving lives Everyone counts

Question 26

What is the role of the handbook to the NHS Constitution?

Answer 26

The handbook is given alongside to the NHS constitution and elaborate on the rights that patients have which is mentioned in the NHS constitution The constitution is redone every 10 years however the handbook is renewed every three years to keep in line with current guidance rights pledges duties, responsibilities established by the constitution

Question 27

What is the NHS mandate? what it’s function?

Answer 27

This is a government mandate to the NHS that sets out their objectives from 2023 onwards written by the Secretary of State for health and social care currently Steve Barclay The current 2023 focus is on reducing NHS wait times and outlines the budget of 14.1 million made available over the next two years to improve elective urgent emergency and primary care performance NHS objectives Cut NHS waitlist and recovery performance Support the workforce to retraining retention and modernisation of the way staff work Deliver recovery through the use of data and technology Continue to work to deliver the NHS long-term plan to transform services and improve out

Question 28

Describe and explain the NHS long-term plan. Mention the seven chapters.

Answer 28

Published January 2019 the document states that we need to tackle head on freshers our staff face while making extra funding goes as far as possible This will be achieved due to one a secure and improve funding path averaging 3.4% a year over five years, the consensus about the change is needed over professionals and NHS frontline and previous success brought by the NHS5 year forward view plan bearing fruit A new service model focused on relieving emergency room pressure through a boost of out of hospital care digitally enabled care and the use of ICS and PCNs More preventative medicine Improvement in cancer, mental health, children’s health and healthy aging including dementia care Specific workforce improvements set out by NHS England/NHS improvement Digital enabled care Returning the NHS to a financially sustainable state Local implementation led by clinicians and leaders who are held accountable for their local healthcare systems and how the plan is implemented

Question 29

Explain the events that led up to the integrated care systems being established

Answer 29

2014. The NHS raised the idea of triple integration between hospitals and GPs. 2016 NHS England asked all parties to begin planning together for a new partnership In 2018 most advanced part of the country will label the first integrated care systems and worked closely with NHS England to pioneer best practice 2019 the release of the NHS long-term plan set the ambition for integrated care by April 2021 ( it became a reality in 2022 April) 2020 Covid pandemic accelerated integrated working so the NHS launch engagement exercises and enhanced proposals for creating statutory ICS 2021NHS confirmed legislative recommendation to the government and Sir Simon Stevens announced that all 42 parts of England had been declared integrated to the care systems and legislation was to be published with implementation set for April 2022 April 2022 the government passed the health care act 2022 confirming the creation of statutory ICS which were established in July

Question 30

How is the NHS funded and what is this money spent on?

Answer 30

The NHS is funded mainly from general taxation however this is supplemented by national insurance contributions. The budget is worked out by the central government through a spending review which takes into account national insurance contributions and the rest would be supplemented by general taxation. Funding from health services comes from the Department of health and social care budget of which plan spending was 180 billion of which two .5 billion is administration costs 153 billion is allocated for commissions of healthcare services Handle through IC BS and NHS England

Question 31

Which payment schemes are used for NHS providers only?

Answer 31

The aligned to payment and incentives (API) is used by almost all NHS providers as an incentive approach for secondary care services including acute maternity community mental health and ambulance services The two components of the API of the fixed element which secure is funding based on agreed level of activity in addition to A&E maternity mental health community ambulance chargeable overseas visitors implementation cost of Meditech API variable element is the soul method for funding elective services switches outpatient procedures and first attend Attendance is un bundled diagnostic imaging and nuclear medicine chemotherapy delivery The LVA is responsible for commissioning accounts with annual value below 500,000 and result in a single fixed value paid once by the ICB and provider

Question 32

Explain the NHS outcomes (NHSOF) framework goal

Answer 32

They are indicators of performance to drive transparency, quality improvement and outcome measurement set out by the Secretary of State It does not deliver how these outcomes should be met as this is down to NHS England The NHSOF has five domains the first three based on effectiveness Preventing people from dying early, enhancing peoples quality of life with long-term conditions, helping people recover from episodes of illness Domain 4 ensuring people have positive experience of care To Man five treating and caring for people in a safe environment protecting them from avoidable harm

Question 33

What is quality and outcomes framework incentive? QOF?

Answer 33

QOF is a voluntary annual reward incentive program for GP practices and it’s point based to where each point is worth £213.43

Question 35

Explain how CQUIN scheme functions

Answer 35

This is an incentive scheme with the financial value of 1.25% of the fixed element of payment of the incentives reached which is paid in advanced and deductions are made based on performance There are 17 indicators in the scheme however the financial incentives will only be editable on the five most important indicators for each contract although reporting on all of the indicators is necessary for all partake The indicators are revise yearly from part of the NHS standard contract which is mandated by NHS England for used by commissioners for all contracts

Question 36

Explain the function of impact and investment fund(IIF)

Answer 36

The IFF supports primary care networks to deliver high-quality care and contains five indicators with 59 million which are divided into two domains It’s split into two domains prevention and tackling health inequalities and providing high-quality care Prevention includes vaccinations and immunisation based on the percentage of 18 to 64 whoever received flu vaccine and vaccinations between two or three years old. as well as tackling health inequalities through percentage of QOF learning disability registered who have received an annual learning disability health check and completed health action plan in addition to recording of ethnicity Providing high-quality care for second domain includes care which is the percentage of gastrointestinal two week weight cancer referrals accompanied by immunochemical test result. And access percentage of appointments where time from booking appointment was two weeks or less. These indicators are points based £198 with the maximum of 262 points

Question 37

What are these three incentive programs for NHS outcome framework?

Answer 37

QOF quality and outcomes framework Commissioning for quality and innovation (CQUINS) IIF impact and investment fund

Question 39

What is the most common patient level intervention and who is capable of doing it?

Answer 39

Prescribing is the most common patient level intervention on the second highest area of spending in the NHS after staffing cost Independent prescribers are responsible for management of undiagnosed and diagnosed conditions and decisions on clinical management these include doctors, pharmacist, physiotherapist, optometrist, paramedics, nurses, dentist Supplementary prescribers is a partnership between independent prescriber and supplementary prescriber to implement an agreed clinical management plan for an individual patient

Question 40

What scheme was introduced in 2019 in partnership with DHSCNHS England and British pharmaceutical industry with the aim of improving access to transformative medicines in a cost-effective manner?

Answer 40

The 2019 voluntary pricing access scheme (VPAS) set out measures for England to support innovation and patient outcomes through access to the most transformative and cost-effective medicines The UK wide affordability mechanism under which members of the scheme make financial contributions to the DHSC Department of sales of branded health service medicines above the allowable growth This promotes innovation to cost-effective medicines and help sustain the NHS finances including commercial engagement up tech support for high value products faster and ICE approvals The scheme ended in 2023 negotiations have begun for a successor

Question 41

What are area prescribing committees (APC)/integrated medicine optimisation committees?

Answer 41

These are meetings of healthcare professionals and managers in the primary secondary care to discuss and agree how best to use medicines and their geographical location Committees called drug and therapeutics committees. Make sure APC recommendations are carried out as they have the rules of. Approving internal medicines related guidelines for any kind Deciding which medicines are added to the formulary or removed A standard drug rating system is the rag red Amber Green in which red drugs are only for hospital administration. Amber drugs can only be initiated or recommended by hospital specialist and green drugs can be prescribed by anyone.

Question 42

Explain regional medicine optimisation committees (RMOC) and their goal

Answer 42

Regional medicine guidance prioritise unused medicine optimisation as an enabler for delivering the ICS 4 key objectives - public health - patient experience – workforce development – NHS financial sustainability This is done through medicine optimisation which is a full principle outcome Aim to understand patient experience – evidence based choice of medicines – ensure medicines use as safe as possible – make medicine optimisation part of routine practice This enables that patients improve the outcomes take medicines correctly. Avoid taking unnecessary medicines reduce waste of medicines and improve medicine safety.

Question 43

In a sentence, what is medical optimisation about?

Answer 43

Making sure the right patients get the right choice of medicines to the right time

Question 44

What is joint working?

Answer 44

this is a specific term that describes a partnership between a pharmaceutical company and the NHS to pool skills and experience and resources to deliver patient centre projects budget aim to deliver triple wins ( in form of benefits to patients, NHS and pharmaceutical company and requires a clear formal joint working agreement which outlines return on investment and investment taken by all parties publicly Examples include economic analysis, facilitation of pathway redesign funding project staff requirements, contribution of nurses identification of undiagnosed patients reviewing uncontrolled patients improve patient adherence to medicines generating patient experience data increased capacity to treat patients

Question 45

Explain the healthcare system in Wales

Answer 45

In 2009 the NHS Wales went through a reorganisation moving away from. We trust and local healthcare board system that existed previously. Now they have seven local healthcare boards (LHB) i’m three trusts including Welsh ambulance – Velindre offering specialist cancer treatment – public health Wales

Question 46

In January 2018 the Welsh Parliament highlighted the current pattern of health and social care provision was not fit for the future what was proposed to fix this issue?

Answer 46

The quadruple aim a document which mirrors the four key ICS principles Improve population well-being through a focus on prevention Improve patient experience Enrich workforce Avoid waste and promote financial efficiency

Question 47

What does the healthier Wales plan for health and social care consist of?

Answer 47

This plan in response to the parliamentary review for a whole system approach to health and social care It aims to introduce seamless local health and social care from a national and local level Investment into digital technologies and coordination of research and innovation through investment into development of health and social care services

Question 48

What is the NHS Wales planning framework?

Answer 48

This is a medium term plan covering the period of 2022 to 2025 and looks ahead the next three years to deliver a sustainable service for patients in Wales to learn to live with Covid Healthier Wales remains the overarching policy context to drive your commitments to deliver a seamless car

Question 49

Who recommends medicines to be available for prescribing in Wales and how many days after this recommendation will be medicine? Be available for prescribing?

Answer 49

The all Wales medicine strategic group is responsible for independent authoritative advice on new medicines advising the government on future development and healthcare and Aidan the Welsh government in prescribing strategy for Wales When NICE AWMSG recommend that medicine can be used the health care boards in the Wales must make sure the medicine is available for prescribe into patients within 60 days of recommendation being published

Question 50

Which scheme in Wales is used to help patients in Wales receive high cost medicines?

Answer 50

The Wales patient access program enables patients to receive high costing medicines and advises the Welsh government on whether the simple or complex scheme will be workable within the NHS Wales

Question 51

Explain the structure of the NHS Scotland

Answer 51

Health can social directorate lead 14 regional NHS boards which are all purpose organisations that plan commission and deliver NHS services in addition to local authorities and seven national or special NHS boards that provide national services Lastly, healthcare improvement Scotland is responsible for scrutiny and public assurance of health services

Question 52

What is the budget of the Scottish government health and social care and where does this funding come from?

Answer 52

19 billion which is funded through public expenditure

Question 53

What are the challenges facing healthcare in Scotland?

Answer 53

Pandemic consequences long-term Aging population Longer-term conditions In increasing complexity of health care needs Overall trends in population health and inequalities Increasing pressure on funding Increasing demand Workforce and Recruitment Sustainable improvement Adapting to new developments in technology digital healthcare Public health challenges include Deaths directly and indirectly from Covid Health inequalities have a worsened over the last 10 years Life expectancy is relatively poor and has not improved since 2012 Climate change potential effect on the foundations of community health and well-being like safe drinking water sufficient food and secure shelter

Question 54

What is the quality management system in Scotland?

Answer 54

A deliberate systematic coordinated approach to improving the quality of care align with improving challenges outlines in healthcare Scotland

Question 55

What is the public health Scotland strategic plan 2020 to 2023

Answer 55

A plan involving three domains Health improvement – improving underlying health determinant Health protection – communal diseases, environment and other threats to health Health public health – improving healthcare systems, service quality practice and effectiveness and economics

Question 56

Which governing body accepts new medicines for Scotland That have received a license from the MHRA or EMA

Answer 56

Prescriptions are free in Scotland The Scottish medicines consortium (SMC) reviews medicines which I’ve received a license from the two governmental bodies although the SMC accepts medicines doctors can put an individual request for medicines for a specific patient and pharmaceutical companies can recommend a patient access scheme for cost-effectiveness

Question 57

What are the government bodies that are responsible for accepting medicines for you in the NHS in Scotland, Wales, Northern Ireland and the UK?

Answer 57

United Kingdom (England & UK-wide) • Medicines and Healthcare products Regulatory Agency (MHRA) – Responsible for licensing medicines and ensuring their safety, quality, and efficacy across the UK. • National Institute for Health and Care Excellence (NICE) – Provides guidance on the cost-effectiveness of medicines for NHS England and Wales and Northern Ireland. 2. Scotland • Scottish Medicines Consortium (SMC) – Assesses new medicines and provides advice on their use within NHS Scotland. 3. Wales • All Wales Medicines Strategy Group (AWMSG) – Reviews medicines not yet assessed by NICE and provides recommendations for NHS Wales.

Question 58

Explain the healthcare system in Northern Ireland

Answer 58

Instead of the NHS, they have the HSC or health and social care and is free at the point of delivery but also provide social care services The department of health is one of nine Northern Island department sale as part of the Northern Ireland executive for Northern Ireland act 1988 and helps Northern Ireland secure the most appropriate and effective abusive resources and services to benefit the community and deliver cost-effective efficient public health

Question 59

Explain the integrated care system Northern Ireland

Answer 59

This is a care system that is being developed in response to the health and social care act 2022 and champions a new way of planning managing delivering our health and social care services based on specific needs of the population through partnership reaching beyond traditional boundaries The key focus being to address the wider determinant of health well-being and population health approach from a angle of prevention and early intervention through treatment and end of life. Care