The health and care system explained

Published 26 March 2013

The new health and care system becomes fully operational from 1 April to deliver the ambitions set out in the Health and Social Care Act. NHS England, Public Health England, the NHS Trust Development Authority and Health Education England will take on their full range of responsibilities.

Locally, clinical commissioning groups – made up of doctors, nurses and other professionals – will buy services for patients, while local councils formally take on their new roles in promoting public health. Health and wellbeing boards will bring together local organisations to work in partnership and Healthwatch will provide a powerful voice for patients and local communities.

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The role of the Department of Health in the new system

The Department of Health’s purpose is to help people live better for longer. We lead, shape and fund health and care in England, making sure people have the support, care and treatment they need, with the compassion, respect and dignity they deserve. The new and changing health and care organisations work together with the Department to achieve this common purpose.

We enable health and social care bodies to deliver services according to national priorities and work with other parts of government to achieve this. We set objectives and budgets and hold the system to account on behalf of the Secretary of State.

The Secretary of State for Health has ultimate responsibility for ensuring the whole system works together to meet the needs of patients and the public and reflect their experiences.

What the changes to the health and care system mean for patients and local communities

Most people won’t notice any immediate difference to how they get the care they need: they will still contact their GP when unwell, or their local council with ongoing personal care needs, and they will continue to receive healthcare free at the point of need just as before. However, some important underlying changes are being made to how the health and care system is run.

These changes are about giving local communities and patients more say in the care they receive and doctors and nurses more freedom to shape services to meet people’s needs, to improve the quality of the support, care and treatment we all receive.

For instance:

  • greater direct control over planning and commissioning means that doctors, nurses and other health and care professionals can better shape what kind of support, care and treatment is available locally

  • more emphasis on preventing illness and helping people stay independent in older age or disability means we can improve everyone’s long term health and wellbeing

  • more power devolved to local groups and organisations means that communities now have more influence than ever over how their local health services support them

  • opening up to a wider range of health care providers, including independent and charitable organisations, means that there will be more choice for patients and greater pressure on services to improve

How health and care organisations will work together locally

  • Clinical Commissioning Groups (CCGs) are made up of doctors, nurses and other professionals who use their knowledge of local health needs to plan and buy services for their local community from any service provider that meets NHS standards and costs – these could be NHS hospitals, social enterprises, voluntary organisations or private sector providers. This means better care for patients, designed with knowledge of local services and commissioned in response to their needs.

  • Health and wellbeing boards in every area ensure that services work together to respond to communities’ needs and priorities. They will involve people and community organisations, including elected representatives, in deciding what services the community needs – this will inform CCGs and local authorities when they commission services.

  • Local Healthwatch, which are represented on health and wellbeing boards, give patients and communities a voice in decisions that affect them. Local healthwatch will report their views and concerns to Healthwatch England so that issues can also be raised at a national level.

  • Local authorities commission care and support services and have a new responsibility to protect and improve health and wellbeing. They use their knowledge of their communities to tackle challenges such as smoking, alcohol and drug misuse and obesity. Working together with health and care providers, community groups and other agencies, they prevent ill health by encouraging people to live healthier lives.

How health and care organisations will work together nationally

  • NHS England supports NHS services nationally and ensures that money spent on NHS services provides the best possible care for patients. It funds local clinical commissioning groups to commission services for their communities and ensures that they do this effectively. Some specialist services will continue to be commissioned by NHS England centrally where this is most efficient. Working with leading health specialists, NHS England brings together expertise to ensure national standards are consistently in place across the country. Throughout its work it promotes the NHS Constitution and the Constitution’s values and commitments.

  • Public Health England provides national leadership and expert services to support public health and works with local government, the NHS and other key partners to respond to health protection emergencies.

  • The NHS Trust Development Authority supports NHS trusts to improve so they can take advantage of the benefits of foundation trust status when they are ready.

  • Health Education England makes sure the healthcare workforce has the right skills and training to improve the care patients receive. It supports a network of Local Education and Training Boards that plan education and training of the workforce to meet local and national needs.

  • The National Institute for Health and Care Excellence (NICE) provides guidance to help health and social care professionals deliver the best possible care for patients based on the best available evidence. NICE involves patients, carers and the public in the development of its guidance and other products.

  • The National Institute for Health Research (NIHR) and its clinical research networks form a health research system in which the NHS supports outstanding individuals, working in world class facilities, conducting leading edge research focused on the needs of patients and the public.

  • The Health and Social Care Information Centre supports the health and care system by collecting, analysing and publishing national data and statistical information and will deliver national IT systems and services to support health and care providers.

  • NHS Blood and Transplant manages the safe supply of blood to the NHS as well as organ donation and transplants across the UK.

  • The NHS Litigation Authority resolves fairly all claims made against its scheme members, helping the NHS to learn from them to improve patient safety.

  • The NHS Business Services Authority carries out a range of support services to the NHS, patients and the public, including payments for community pharmacists filling prescriptions and dentists carrying out NHS treatment.

How the interests of people using health and care services are protected

As the new system brings more freedom for those who plan, commission and provide services, new and existing health and care regulators will safeguard the interests of patients and the wider public.

  • The Care Quality Commission (CQC) measures whether services meet national standards of quality and safety, ensuring that people are treated with dignity and respect. Healthwatch England works as part of the CQC.

  • Monitor protects and promotes the interests of people using health services by making sure that NHS services are effective and offer value for money. Licensing providers of health care will be one of the main tools Monitor will use to do this.

  • The Health Research Authority works to protect and promote the interests of patients and the public in health research.

  • The Medicines and Healthcare Products Regulatory Agency makes sure that medicines and medical devices work and are safe to use.

  • The Human Tissue Authority regulates human tissue, such as donated organs, to ensure it is used safely and ethically, and with proper consent.

  • The Human Fertilisation and Embryology Authority regulates fertility treatment and the use of embryos in research.

  • Most health and social care professionals must be registered with one of the independent regulators, such as the General Medical Council, who help protect patients and public by ensuring that professional standards are met.