How does the NHS in England work and how is it changing?

Big changes are taking place across the health and care system

• What does this mean for the organisations that make up the NHS?  
• How will they collaborate with other parts of the system?  
• And what’ll these changes mean for you and me?  

When the NHS was set up, it focused on treating single conditions or illnesses. 

Since then, our health and care needs have changed; more of us are living longer and many have multiple conditions that require regular, ongoing care.  

However, this hasn’t been reflected in the NHS’s structure, a patchwork of organisations that often work independently from one another. Navigating this can be confusing and can have a negative impact on our experience of care.  

So, for some years now, health and care staff and leaders, have been working to bring organisations closer together to better meet our needs by working in a joined-up way.  

Primary and secondary care, social care, mental health and community health services have been seeking to partner with each other in different ways.  
 
At a very local level, GP surgeries have been coming together to form primary care networks, groups of practices working together across areas called ‘neighbourhoods’. By sharing resources and working closely with other local people and services, they can provide a wider range of services than a single GP surgery.  

Health and care organisations have also been working together across larger areas called ‘places’ – often covering the same area as a local authority – where large parts of the NHS budget are spent. Here, local government, charities, residents and NHS partners can work together to understand and meet local health needs.  

But previous laws have prevented services becoming even more joined-up.  

The 2022 Health and Care Act aims to change this and make it easier for organisations to work together.  

But what do these changes look like?  

Organisations are now coming together across even larger areas to form integrated care systems, partnerships of health and care organisations that plan and pay for health and care services.  

There are around 40 integrated care systems across England and although they’ve existed for some time, the Health and Care Act gives them legal status, as well as new powers and responsibilities.  

Integrated care systems are made up of two parts: integrated care boards and integrated care partnerships.  

Integrated care boards decide how the NHS budget for their area is spent and develop a plan to improve people’s health, deliver higher-quality care and better value for money.  

Integrated care partnerships bring the NHS together with other key partners, like local authorities, to develop a strategy to enable the integrated care system to improve health and wellbeing in its area. 

NHS trusts are also coming together to form provider collaboratives, new partnerships that can bring together providers such as hospitals, mental health services and community services. 

So, how are these new structures funded? 

Integrated care systems get most of their money from NHS England, which is the national body for the NHS in England, and sets the operational priorities for the health system.  

It’s responsible for the health services you and I access day to day, which are inspected and regulated by the independent Care Quality Commission. 
 
The Department of Health and Social Care sets out what the NHS is expected to deliver for the money it gets from the government – which comes from our taxes. It also holds budgets for some of the other areas that have an impact on our wellbeing, like public health.   

Throughout these new structures, local authorities play a key role; they receive money locally and from national government, which goes towards funding a range of services that support our wellbeing and prevent ill health.  

So, what does this all mean in practice?  

The Health and Care Act has put in place a legal framework, that enables services to work more closely together, so it’s easier for you and I to receive the care we need, when and where we need it.  

For these changes to succeed, staff and local leaders will have to work with one another differently, alongside key partners in local government, the voluntary sector, and communities themselves. 

Of course, services face other challenges, like workforce shortages, growing waiting lists and the impact of the Covid-19 pandemic.  

While the new structures won’t fix all these issues, by enabling services to work more closely together and join up services for patients, it’s hoped that the health and care system will be better able to meet our changing health and care needs in the future.   

Find out more about how the health and care system is changing via the links below: