The NHS from 2010

The NHS from 2010

For England, the Secretary of State for Health has responsibility for the NHS and for leading the Department of Health. In Scotland the NHS is a devolved responsibility; the Scottish parliament has legislative power and the minister for health and community care is responsible for the service. In Wales the National Assembly has responsibility for the NHS. Within the Welsh Assembly government, the Health and Social Services Secretary is lead for the service. A similar pattern applies in Northern Ireland where there is a Department of Health, Social Services and Public Safety.

England

At the time of writing, the NHS in England faces a period of very significant change. The White Paper, Equity and Excellence Liberating the NHS, and the supporting consultation papers, set out wide-ranging structural changes, though there is a clear intent to build upon the work of the Next Stage Review undertaken by Lord Darzi. Strategic health authorities and PCTs will be abolished and GP consortia will be responsible for commissioning care from providers. All hospital trusts will become foundation trusts, perhaps nearer to their original design. The process based targets, such as waiting lists, are to be replaced by outcomes measures with the Secretary of State monitoring health outcomes to see how the NHS is performing. Public health will take a more prominent role, keeping people healthy rather than simply investing to deal with illness; this is set out in the White Paper Healthy Lives, Healthy People: our strategy for public health in England. Regulation of healthcare will be in the hands of Monitor (the economic regulator originally set up to regulate foundation trusts) and of the Care Quality Commission (CQC). CQC was established in 2009, replacing the Healthcare Commission, and regulates health and social care (for additional information see www.cqc.org.uk). Their role is to ensure ‘better care is provided for everyone’, which they do through a licensing system, supported by inspection and in accordance with standards. Within their guidance for health organisations, outcome 9 addresses medicines.

The White Paper, Equity and Excellence Liberating the NHS, detailed the difficult financial challenge facing the NHS in 2010 following banking rescues and a period of recession. Whilst year-on-year investment was promised, the investment would be below that of earlier years and not at a pace that met expected new demand. The planned response was QIPP quality, innovation, productivity, prevention. In essence, increasing the quality of care to reduce costs, for example improving medicines use in asthma could prevent admissions, in all reducing the spend on care.

The White Paper also confirmed the NHS constitution, first set out in 2009, that sets out the rights and responsibilities for patients and staff using or working in the NHS. The right to receive medicines approved by NICE if they are considered appropriate for the individual is enshrined in the document.

Scotland

The responsibility for NHS Scotland and for the development and implementation of health and community care policy lies with the Scottish Government Health Directorate. There are 14 NHS boards, each responsible for planning health services for its local population, with the chief executive for NHS Scotland accountable to the government for the service. Additionally, the Scottish Ambulance service and NHS 24 (the helpline for access to medical advice) is part of their responsibility. The provider–commissioner split developed in England does not play a part in NHS Scotland.

In 2010, the Scottish government published The Healthcare Quality Strategy for NHS Scotland, setting out the way in which high-quality care would be achieved care that is compassionate, with clear communications, in clean environments, where there is collaboration, continuity of care and clinical excellence. Specific mention is made of the need to have medicines reconciliation in place for transfers of care.

Wales

The NHS in Wales underwent a major reorganisation in 2009. The trust health board split previously in place was removed, creating seven health boards, each responsible for organising and delivering all healthcare for its population. The stated aim was that by replacing the market-style approach, which remains in England, a better-coordinated NHS could be developed. In addition to the health boards are three trusts: (1) the Welsh Ambulance Services Trust for emergency services; (2) Velindre NHS Trust, providing specialist services in cancer care and other national support services; and (3) Public Health Wales.

Northern Ireland

There is much closer working between health and social care in Northern Ireland than in Britain. The four health and social service boards work in a similar way to health authorities in England (pre-2002) but with the addition of a social care remit. They commission services for their local population from health and social service provider organisations.