Organisation and Management of the NHS Flashcards
When was the NHS created?
1948
What was the NHS created as part of?
The welfare state
What are the core principles of the NHS?
- Universal
- Comprehensive
- Free at the point of delivery
What is meant by the NHS being universal?
Covers everyone
What is meant by the NHS being comprehensive?
Covers all health needs
What is meant by the NHS being free at the point of delivery?
It is available to everyone based on need, not ability to pay
Who has a duty to provide health services?
Secretary of State for Health
How was the NHS initially run?
Centrally, by the Department for Health
What changes to the NHS happen in the 1950’s and 60’s?
Changes to what consituted a health need
How is there an increasing role for managers in the NHS?
More strategic management roles
Why is there increasing marketisation of provision in the NHS?
Competition between hospitals
What is the aim of competition between hospitals in the NHS?
Aimed at improved choice and quality, and contains cost
What current reforms are happening in the NHS?
- Commissioning
- Health and Social Care Act (2012)
What happens in commissioning in the NHS?
The commissioners act as ‘customers’, choosing between different care providers on patient’s behalf
What do commissioners choose on the basis of?
- Cost
- Patients’ needs
- Quality
What changes were made in the Health and Social Care Act of 2012?
- 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 is an increased use of markets achieved?
Opportunities for NHS staff to set up their own care organisations, ‘social enterprises’
What is the budget given in the Health and Social Care Act 2012?
£100bn
What is the result of devolution?
Scotland, Wales, and Northern Ireland each have differently organised NHS
How is the Scottish NHS organised?
‘Health Boards’, which are integrated regional organisations
How are the Welsh and Northern Irish NHS’s organised?
Have ‘provider-purchaser’ split, similar to England
Draw a diagram illustrating the structure of the NHS
Who has overall accountability for the NHS?
The Secretary of State for Health
What does the Department of Health do?
- Sets overall national standards
- Shapes direction of the NHS and social care services
- Sets national tariff
What is the ‘national tariff’?
Fee for services charged by service providers, e.g. to hospital trusts, to commissioners, i.e. CCGs
What does NHS England do?
- Authorises Clinical Commissioning Groups
- Supports, develops, and performance manages commissioning
- Commissions specialist services, primary care, and some others
Where are CCGs crucial?
In the new organisation of the NHS
What do CCGs do?
Bring together groups to commission secondary and community healthcare services
What healthcare services do CCGs commission?
- GPs
- Nurses
- Public health
- Patient’s
- Public
- Others
What must CCGs account for in their decisions?
National guidance from NHS England, NICE etc
How much of the NHS budget are CCGs responsible for the flow of?
Around 65%
What is public health now the responsibility of?
Local authorities
Who now commissions general primary care services?
NHS England
Who are the provider organisations?
- Hospitals
- Mental health trusts
- Community services
- General practice
How has the 2012 Health and Social Care act changed things for the provider organisations?
Not much has changed, but the act opens new opportunities for competition
What do CCGs and NHS England commission providers to do?
Provide care for the populations they serve
What providers do CCGs and NHS England commission?
- NHS acute trusts
- Community healthcare trusts
- Ambulance service trusts
- GP practices
- Other providers including private sector
How do NHS hospital trusts earn most of their income?
Through services that CCGs and NHS England commission from them
Other than commissed services, how else do NHS acute trusts get income?
From the provision of undergraduate and postgraduate training
How can high-performing trusts earn greater financial and managerial autonomy?
By gaining foundation trust (FT) status
Where does money flow through the commissioning process?
From CCGs and NHS England, to NHS trusts and other providers
Can commissioners place contracts with private/voluntary sectors?
Yes
What other organisations are involved in the NHS?
- Monitor
- Care Quality Commission
- National Institute for Health Care Excellence (NICE)
- Commissioning Support Units
- Healthwatch
- Public Health England
- Health and Wellbeing Boards
- Clinical senates
What does Monitor do?
Regulates financial and corporate governance of NHS trusts
What is the focus on with the Care Quality Commission?
Quality of care provided to NHS patients
What do the National Institute for Health and Care Excellence do?
- Provides commissioning guidance to CCGs
- Provides quality standards to providers
What do Commissioning Support Units do?
Provide analysis and expertise to CCGs to assist with commissioning decisions
What is Healthwatch?
National and local bodies to facilitate patient and public involvement
What do Public Health England do?
Coordination and leadership for public health
How is Public Health England now primarily conducted?
In local authorities
What are Health and Wellbeing Boards?
Local bodies to facilitate joint strategy around healthcare, social care, and public health between CCGs and local authorities
What do clinical senates do?
Offer CCGs advice from hospital specialists and others
What are the current developments in the NHS?
- Increasing number of ‘managerial’ roles for clinicians
- ‘Clear out’ of layers of bureaucracy
- High Quality Care for All (2008)
- Liberating the NHS (2010)
What are the management roles for doctors?
- Medical director
- Clinical director
- Consultant
- General practitioner
What does a medical director do?
Overall responsible for medical quality
What does a clinical director do?
Has overall responsibility for directorate
What does a consultant do?
Has overall responsibility for a team
What are the management roles for GPs?
Practice principal or partner
Who are senior and middle managerial roles filled by?
Often nurses and AHPs, rarely doctors
What senior and middle managerial roles are there?
- Chief executive
- General manager roles
At what level will a doctors role include managerial responsibilities of some kind?
Any level, including training graduates
What does High Quality Care for All say that all clinicians should have the opportunity to be?
- A ‘partner’
- A ‘leader’
What is meant by a clinician being a ‘partner’?
Taking responsibility for the management of finite resources
What is meant by a clinician being a ‘leader’?
Working with other clinicians and managers to change systems where it will benefit patients
What does Liberating the NHS (2010) do?
Sets out growing management roles for doctors, especially in primary care
What management roles for doctors are set out in Liberating the NHS?
- Resource allocations and decision making, especially GPs, but others too
- Contract management
What are hospital trusts usually organised into?
Clinical directorates
What are clinical directorates usually based on?
A speciality, or a group of specialities
What is each clinical directorate led by?
A clinical director, who will be a doctor
Who will the directorate usually include alongside the clinical director?
A lead nurse and general (non-clinical) manager
How does the power of the non-clinical manager compare to that of the clinical director?
They have an important role, but are subordinate to clinical director
What is the role of the clinical director?
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
What is the medical director responsible for?
Quality of medical care
What is the role of a medical director?
- 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
How is the medical director important in leadership of medical staff?
- Sets out strategy
- Exemplifies positive values
- Help to implement change
What can medical culture be hostile to?
Both clinical and non-clinical manager s
What is the problem with medical culture being hostile to both clinical and non-clinical managers?
Since 1980s, managers expected to have a strategic role, not just administer
What does the NHS being prone to hostile and difficult collegial relationships have implications for?
Quality and safety of care
Give two examples of where difficult collegial relationships had implications for quality and safety of care?
- Bristol Royal Infirmary
- Mid staffs
Why can there be great difficult in managing change?
- Imposing authority
- ‘Treading on toes’
- Changing power relationships
What is the GMC guidance on managing teams?
- 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
