Organisation of the NHS

Question 1

What are the different levels of management within the NHS?

Answer 1

Department of Health = sets national standards, shapes direction of NHS & social care services, sets national tariffs

NHS England = authorises Clinical Commissioning Groups (CCGs), supports commissioning, commissions specific services

CCGs = bring together GPs, nurses, public health, public, and others to commission secondary and community health services (used to be responsibility of Secretary of State for Health)

• must account for national guidance in those decisions (NHS England, NICE, etc.)
• responsible for 65% of NHS budget flow (except for public health which is now the responsibility of local authorities & general primary care services which are now commissioned by NHS England)

Question 2

Give some examples of commission providers.

Answer 2

Hospitals
Community healthcare trusts
Private providers
Voluntary sectors

Question 3

What management roles can individuals hold in the NHS?

Answer 3

High Quality Care for All (2008) = all clinicians should have the opportunity to be a “partner” (taking responsibility for management of finite resources) and a “leader” (working with other clinicians and managers to change systems where it will benefit patients)

Medical director = responsible for quality of medical care provided by doctors in a hospital

• communicates between the board and the medical staff (link between medical staff and senior management)
• leadership of medical staff: sets out strategy, exemplifies positive values, helps to implement changes
• works in partnership with human resources/personnel

Clinical director = manage directorate (with lead nurse and general manager) i.e. their own facility within the hospital

• provide continuing medical education and other training
• design & implement directorate policies on junior doctors’ hours of work, supervision, tasks, and responsibilities
• implement clinical audits
• develop management guidelines & protocols for clinical procedures
• induction of new doctors

+ consultants, GPs, etc.

Question 4

Define clinical governance.

Answer 4

Statutory duty for quality of care in healthcare organisations (1999)

Framework by which NHS organisations are ACCOUNTABLE for continually improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish

• patient involvement
• risk management
• clinical audit
• staffing & staff management
• education & training
• clinical effectiveness
• use of clinical information

Question 5

What are some of the new changes to the NHS?

Answer 5

Sainsbury’s executive (Griffiths) - no medical expertise, private business standpoint

Marketisation theory = increased flexibility, increased responsibility to needs, improvement in services drives change

Puts services “out to tender” = gets other providers (NHS or private) to bid for providing the service

No increases in NHS budget but demand has been increasing (hence why £20bn needs to be saved per year)

Question 6

What is a national tariff?

Answer 6

Set fee for most NHS interventions i.e. how much the commissioners have to pay for the providers for the service (NHS is not a free market)

• providers cannot undercut each other/overprice things therefore competition is based on quality/accessibility of services instead of cost (patients kept safe in terms of avoiding cheap but low quality services)
• if service is cheaper than tariff the provider can invest in other things/give to shareholders
• if service is more expensive than tariff the provider can pull out of service, or subsidise it with other services that make a profit, or re-evaluate how they are providing that service

Question 7

What does foundation trust status mean?

Answer 7

Gives hospitals more autonomous control over budget e.g. borrowing money to invest

Question 8

What are commissioning support units?

Answer 8

Help CCGs (GPs) with finance, accounting, public health, etc.

note: in future, private sectors can apply for this, but currently they are paid for by CCGs themselves

Question 9

What are clinical senates?

Answer 9

Groups which think strategically about options, not just on cost basis

Question 10

Give some examples of the criticisms of privatisation.

Answer 10

• risk of splitting NHS services which are reliant on each other e.g. cataract services privately contracted —> NHS loses money on providing cataract services —> affects services subsidised by cataract service contract money
• loss of training opportunities e.g. cannot train junior staff how to do cataract operations
• private companies could selectively obtain the most lucrative services —> NHS is less financially stable

Question 11

Outline the history of the NHS.

Answer 11

Created in 1948; core principles are:

• universal = covering everyone (includes non-citizens & non-residents)
• comprehensive = covering all health needs
• free at point of delivery = available to all based on need, not ability to pay

1950s-60s:

• increasing role for managers
• increasing marketisation of provision = competition between hospitals, separation of commissioners and providers of care
• commissioning = commissioners act as “consumers”, choosing between different core providers on patients’ behalf (choosing based on need, cost, & quality)

Health & Social Care Act (2012):

• devolves power to GPs and others in primary care (better understanding of patient needs & best services)
• increased use of markets, with opportunities for NHS staff to set up “social enterprises”
• requires efficiency savings of £20bn/yr (on a budget of £100bn)
• £5bn of services put out for contract in 2013 out of a total of £120bn (50% of which to private providers, inc. voluntary providers)