Guide to new health and care system

This page provides a brief introduction to the statutory bodies making up the new health and care system, explaining how they will work together in the interests of patients and communities.

The new health and care system

The health and care system helps people lead healthier lives, recover well from illness and live better for longer into old age. The way the system works is changing but there will be no change to the core values of the NHS – health care will remain free at the point of use, funded from taxation, and based on need and not the ability to pay. People using care and support services will have more control over the services they use. All professionals working in health and care share a commitment to working together to provide fair and equal access to high quality services, in response to patients’ individual needs and choices.

The need for change

The health and care system is facing the biggest set of challenges in its history. Scientific and technological advances mean that we can treat illness more effectively than ever before, but new drugs and treatments are expensive. With better health care, people are living longer than their parents and grandparents. This is an achievement to celebrate, but this trend also means greater pressure on health and care services to maintain people’s wellbeing and quality of life for longer.  Despite these advances, good health is not shared by all – inequalities persist between communities and regions, with preventable ill health creating significant challenges.  We need to get better value from public spending, to invest more in preventing ill health, to enable people to stay in their own homes and to continue to drive improvements in care.

Empowering patients and local communities

The new system is designed to deliver better health, better care and better value for money. Changes will be led by doctors, nurses and other health and care professionals, working with local authorities and local service providers, in response to the needs of patients, people using care services, carers and communities. The new system will focus more on preventing ill health and empower local communities to plan services according to their local priorities. People will have more say in the care they receive and doctors and nurses will have more freedom to shape services to meet people’s needs. A wider range of health care providers will provide more choice for patients and greater value.

Good health begins in our communities. At the heart of the new system are the local health and care services people use on a daily basis – GP surgeries, home care, hospitals and care homes. Family doctors, nurses, pharmacists and online/telephone services will continue to be the first port of call for most people needing health care. As well as providing patient care, in the new system, doctors, nurses and other professionals will use their knowledge of local health needs to commission the best available services to meet them. They will do this by joining together to form Clinical Commissioning Groups (CCGs). CCGs will have the freedom to commission services for their local community from any service provider which 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 will ensure that services work together and are responsive to communities’ needs and priorities. Local Healthwatch will give patients and communities a voice in decisions which affect them, reporting into Healthwatch England, a new national body to represent the views of the public at the highest level.

Local authorities will commission care and support services and have a new responsibility to protect and improve health and wellbeing and will 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 will prevent ill health by encouraging people to live healthier lives. A new organisation, Public Health England, will provide national leadership and expert services, to support public health and work with local government and the NHS to respond to emergencies.

Most people will need care and support at some point in their lives, because they are getting older, have developed an illness or have lived with a disability since birth. Alongside their health care, people need the right combination of care and support – financial, practical and emotional – to manage day-to-day living. Care and health services will be organised to work together to provide seamless services that respond to people’s individual needs and choices, including personal budgets to choose the care that is best for them.

Supporting providers of care

NHS services nationally will be supported by the new NHS Commissioning Board (NHS CB). It will fund local CCGs to commission services for their communities and ensure that they do this effectively. Some specialist services will continue to be commissioned by the NHS CB centrally where this is most efficient. Working with leading health specialists, the NHS CB will bring together expertise to ensure national standards are consistently in place across the country, maintaining the ‘N’ in the NHS. Throughout its work it will promote the NHS Constitution.

Health trusts will continue to manage hospital care and community and mental health services, with all trusts becoming Foundation Trusts to benefit from greater independence to manage their own services.  They will be able to innovate, introducing new approaches to provide the services local CCGs want to commission and they will be able to generate private income to bolster their budgets to the benefit of NHS patients. A new NHS Trust Development Authority will support NHS Trusts to improve so they can take advantage of the benefits of foundation trust status when they are ready.

High quality patient care demands first class education and training of health professionals. A new organisation, Health Education England will make sure the healthcare workforce has the right skills and training to improve the care patients receive. It will support a network of Local Education and Training Boards (LETBs) that will plan education and training of the workforce to meet local and national needs.

The National Institute for Health and Care Excellence (NICE) will provide guidance to help health and social care professionals deliver the best possible care based on the best available evidence.

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 will collect, analyse and publish national data and statistical information and will deliver national IT systems and services to support health and care providers.

NHS Blood and Transplant will continue to manage the supply of blood to hospitals as well as organ donation and transplants across the UK. The NHS Litigation Authority will resolve fairly all claims made against NHS Trusts and will help the NHS to learn from them to improve patient safety. The NHS Business Services Authority will continue to carry out a range of support services including payments for community pharmacists filling prescriptions and dentists carrying out NHS treatment.

Safeguarding the interests of people using health and care services

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) will assess the quality and safety of services against government standards through its registration, regulation and monitoring of services, ensuring that people are treated with dignity and respect. Healthwatch will give patients and communities a voice in decisions which affect them, reporting their views, experiences and concerns to Healthwatch England. Healthwatch England will work as part of the CQC.

As the sector regulator, Monitor’s main duty will be to protect and promote patients’ interests by creating incentives, providing information and enforcing rules where necessary. Licensing providers of health care will be one of the main tools Monitor will use to do this.

The Health Research Authority (HRA) will work to protect and promote the interests of patients and the public in health research. The Medicines and Healthcare Products Regulatory Agency (MHRA) will continue to make sure that medicines and medical devices work and are safe to use. The Human Tissue Authority (HTA) 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 (HFEA) regulates fertility treatment and the use of embryos in research.

Health and care professionals are registered with the relevant health and social care regulator, which ensures that professional standards are met.

The Secretary of State for Health has ultimate responsibility for ensuring the whole system works together to respond to the priorities of communities and meet the needs of patients. The Department of Health will empower health and social care bodies to deliver according to national priorities and will work with other parts of government to achieve this. It will set objectives and budgets and hold the system to account on behalf of the Secretary of State.

Managing a smooth transition

The new health and care system will be up and running by April 2013. The vital services people value will continue as usual during the period of transition. New organisations, and changes to existing roles, are being developed in parallel over the course of this year to ensure there is no disruption or drop in standards of care. The Government is working with local government and the health and care sector to make improvements to services and implement the reforms. As the new system takes shape, the needs of the patients and communities we serve will be at the heart of all we do.

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