Organisation and Management of the NHS Flashcards

1
Q

When was the NHS created?

A

1948

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What was the NHS created as part of?

A

The welfare state

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the core principles of the NHS?

A
  • Universal
  • Comprehensive
  • Free at the point of delivery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is meant by the NHS being universal?

A

Covers everyone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is meant by the NHS being comprehensive?

A

Covers all health needs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is meant by the NHS being free at the point of delivery?

A

It is available to everyone based on need, not ability to pay

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Who has a duty to provide health services?

A

Secretary of State for Health

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How was the NHS initially run?

A

Centrally, by the Department for Health

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What changes to the NHS happen in the 1950’s and 60’s?

A

Changes to what consituted a health need

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How is there an increasing role for managers in the NHS?

A

More strategic management roles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Why is there increasing marketisation of provision in the NHS?

A

Competition between hospitals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the aim of competition between hospitals in the NHS?

A

Aimed at improved choice and quality, and contains cost

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What current reforms are happening in the NHS?

A
  • Commissioning
  • Health and Social Care Act (2012)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What happens in commissioning in the NHS?

A

The commissioners act as ‘customers’, choosing between different care providers on patient’s behalf

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What do commissioners choose on the basis of?

A
  • Cost
  • Patients’ needs
  • Quality
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What changes were made in the Health and Social Care Act of 2012?

A
  • Devolves power (especially commissioning) to GPs and others in primary care
  • Shakes up the NHS’s structure significantly
  • Increases use of markets
  • Requries efficiency savings of £20bn per annum
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How is an increased use of markets achieved?

A

Opportunities for NHS staff to set up their own care organisations, ‘social enterprises’

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the budget given in the Health and Social Care Act 2012?

A

£100bn

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the result of devolution?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How is the Scottish NHS organised?

A

‘Health Boards’, which are integrated regional organisations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How are the Welsh and Northern Irish NHS’s organised?

A

Have ‘provider-purchaser’ split, similar to England

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Draw a diagram illustrating the structure of the NHS

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Who has overall accountability for the NHS?

A

The Secretary of State for Health

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What does the Department of Health do?

A
  • Sets overall national standards
  • Shapes direction of the NHS and social care services
  • Sets national tariff
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the ‘national tariff’?

A

Fee for services charged by service providers, e.g. to hospital trusts, to commissioners, i.e. CCGs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What does NHS England do?

A
  • Authorises Clinical Commissioning Groups
  • Supports, develops, and performance manages commissioning
  • Commissions specialist services, primary care, and some others
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Where are CCGs crucial?

A

In the new organisation of the NHS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What do CCGs do?

A

Bring together groups to commission secondary and community healthcare services

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What healthcare services do CCGs commission?

A
  • GPs
  • Nurses
  • Public health
  • Patient’s
  • Public
  • Others
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What must CCGs account for in their decisions?

A

National guidance from NHS England, NICE etc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

How much of the NHS budget are CCGs responsible for the flow of?

A

Around 65%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is public health now the responsibility of?

A

Local authorities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Who now commissions general primary care services?

A

NHS England

34
Q

Who are the provider organisations?

A
  • Hospitals
  • Mental health trusts
  • Community services
  • General practice
35
Q

How has the 2012 Health and Social Care act changed things for the provider organisations?

A

Not much has changed, but the act opens new opportunities for competition

36
Q

What do CCGs and NHS England commission providers to do?

A

Provide care for the populations they serve

37
Q

What providers do CCGs and NHS England commission?

A
  • NHS acute trusts
  • Community healthcare trusts
  • Ambulance service trusts
  • GP practices
  • Other providers including private sector
38
Q

How do NHS hospital trusts earn most of their income?

A

Through services that CCGs and NHS England commission from them

39
Q

Other than commissed services, how else do NHS acute trusts get income?

A

From the provision of undergraduate and postgraduate training

40
Q

How can high-performing trusts earn greater financial and managerial autonomy?

A

By gaining foundation trust (FT) status

41
Q

Where does money flow through the commissioning process?

A

From CCGs and NHS England, to NHS trusts and other providers

42
Q

Can commissioners place contracts with private/voluntary sectors?

A

Yes

43
Q

What other organisations are involved in the NHS?

A
  • Monitor
  • Care Quality Commission
  • National Institute for Health Care Excellence (NICE)
  • Commissioning Support Units
  • Healthwatch
  • Public Health England
  • Health and Wellbeing Boards
  • Clinical senates
44
Q

What does Monitor do?

A

Regulates financial and corporate governance of NHS trusts

45
Q

What is the focus on with the Care Quality Commission?

A

Quality of care provided to NHS patients

46
Q

What do the National Institute for Health and Care Excellence do?

A
  • Provides commissioning guidance to CCGs
  • Provides quality standards to providers
47
Q

What do Commissioning Support Units do?

A

Provide analysis and expertise to CCGs to assist with commissioning decisions

48
Q

What is Healthwatch?

A

National and local bodies to facilitate patient and public involvement

49
Q

What do Public Health England do?

A

Coordination and leadership for public health

50
Q

How is Public Health England now primarily conducted?

A

In local authorities

51
Q

What are Health and Wellbeing Boards?

A

Local bodies to facilitate joint strategy around healthcare, social care, and public health between CCGs and local authorities

52
Q

What do clinical senates do?

A

Offer CCGs advice from hospital specialists and others

53
Q

What are the current developments in the NHS?

A
  • Increasing number of ‘managerial’ roles for clinicians
  • ‘Clear out’ of layers of bureaucracy
  • High Quality Care for All (2008)
  • Liberating the NHS (2010)
54
Q

What are the management roles for doctors?

A
  • Medical director
  • Clinical director
  • Consultant
  • General practitioner
55
Q

What does a medical director do?

A

Overall responsible for medical quality

56
Q

What does a clinical director do?

A

Has overall responsibility for directorate

57
Q

What does a consultant do?

A

Has overall responsibility for a team

58
Q

What are the management roles for GPs?

A

Practice principal or partner

59
Q

Who are senior and middle managerial roles filled by?

A

Often nurses and AHPs, rarely doctors

60
Q

What senior and middle managerial roles are there?

A
  • Chief executive
  • General manager roles
61
Q

At what level will a doctors role include managerial responsibilities of some kind?

A

Any level, including training graduates

62
Q

What does High Quality Care for All say that all clinicians should have the opportunity to be?

A
  • A ‘partner’
  • A ‘leader’
63
Q

What is meant by a clinician being a ‘partner’?

A

Taking responsibility for the management of finite resources

64
Q

What is meant by a clinician being a ‘leader’?

A

Working with other clinicians and managers to change systems where it will benefit patients

65
Q

What does Liberating the NHS (2010) do?

A

Sets out growing management roles for doctors, especially in primary care

66
Q

What management roles for doctors are set out in Liberating the NHS?

A
  • Resource allocations and decision making, especially GPs, but others too
  • Contract management
67
Q

What are hospital trusts usually organised into?

A

Clinical directorates

68
Q

What are clinical directorates usually based on?

A

A speciality, or a group of specialities

69
Q

What is each clinical directorate led by?

A

A clinical director, who will be a doctor

70
Q

Who will the directorate usually include alongside the clinical director?

A

A lead nurse and general (non-clinical) manager

71
Q

How does the power of the non-clinical manager compare to that of the clinical director?

A

They have an important role, but are subordinate to clinical director

72
Q

What is the role of the clinical director?

A

Manage their directorate as a whole;

  • Provide continuting medical education and other training
  • Design and implement directorate policies on junior doctors’ hours of work, supervision, tasks, and responsibilities
  • Implement clinical audit
  • Develop management guidelines and protocols for clinical procedures
  • Induction of new doctors
73
Q

What is the medical director responsible for?

A

Quality of medical care

74
Q

What is the role of a medical director?

A
  • Communicates between board and the medical staff
  • Leadership of medical staff
  • Will work in partnership with human resources/personnel functions
  • Approves job descriptions
  • Interview panels and equal opportunities
  • Discretionary pay awards
  • Disciplinary processes
  • Leads on organisations clinical policy and clinical standards
  • Stratetic overview of medical staff’s role in the organisation
  • Sits on organisations Board of Directors
75
Q

How is the medical director important in leadership of medical staff?

A
  • Sets out strategy
  • Exemplifies positive values
  • Help to implement change
76
Q

What can medical culture be hostile to?

A

Both clinical and non-clinical manager s

77
Q

What is the problem with medical culture being hostile to both clinical and non-clinical managers?

A

Since 1980s, managers expected to have a strategic role, not just administer

78
Q

What does the NHS being prone to hostile and difficult collegial relationships have implications for?

A

Quality and safety of care

79
Q

Give two examples of where difficult collegial relationships had implications for quality and safety of care?

A
  • Bristol Royal Infirmary
  • Mid staffs
80
Q

Why can there be great difficult in managing change?

A
  • Imposing authority
  • ‘Treading on toes’
  • Changing power relationships
81
Q

What is the GMC guidance on managing teams?

A
  • Problems can arise when communication is poor, or responsibilities are unclear
  • Each member of the team should know where responsibility lies for clinical and managerial issues, and who is leading the team
  • Systems should be in place to facilitate collaboration and communication between team members
  • Systems should be in place to monitor, review and, if appropriate, improve the quality of the team’s work
  • Teams should be appropriately supported and developed, and be clear about their objectives