NHS Structures and Managment

Question 1

Give a brief history of the NHS

Answer 1

Created in 1948 as part of a welfare state
Three core principles:
- Universal (covering everyone)
- Comprehensive (covering all health needs)
- Free at point of delivery
Initially run centrally by department of health.
Some changes in 1950s and 1960s

Then there was an increasing role for managers:

• Griffiths report (1983) said it was bad
• More strategic management roles

The increasing marketization of provision:
- Competition between hospitals: aimed at improving
choice and quality, containing costs
- Separation of ‘commissioners’ and ‘providers’ of care

Question 2

What are the current reforms of the NHS?

Answer 2

Commissioning
- 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

Health and Social Care Act (2012):
- Devolves power (especially commissioning) to GPs
and others in primary care
- Shakes up NHS’s structure significantly
- 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 3

How has the structure of the NHS changed?

Answer 3

Instead of just the secretary of state overseeing health authorities overseeing primary care trusts that put money into health services which care for a patient.

The secretary of state for health oversees a NHS England which allocates money to 240 commissioning groups and money directly to GPs and Dentists and the like.

NHS England also oversees four regional hubs which oversee 50 local offices of the board that oversee the commissioning groups

The commissioning groups then allocate money to hospitals and mental health units and the like.

Question 4

What does the secretary of state for health now do?

Answer 4

Overall accountability for NHS

Oversees national board

Question 5

What does the department of health do?

Answer 5

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) - So it says that no matter who provides the service they will get the same money, so it removes cost cutting providers, just the best provider gets the money

Question 6

What does NHS England do?

Answer 6

Authorises Clinical Commissioning Groups

Supports, develops and performance-manages commissioning

Commissions special services, primary care, and some others