S2 5 - Structure and Organisation of the NHS II

Question 1

What is primary care?

Answer 1

Generally first point of contact
Includes GPs, pharmacists, dentists, optometrists, NHS-walk-in centres, NHS 111, nurse practitioners, can include other HCP

Question 2

What is secondary care?

Answer 2

Care received after referral by primary care provider
Includes planned hospital care, acute care and emergency care (A&E), community care, rehabilitative services, mental health services, ambulances

Question 3

What is tertiary care?

Answer 3

Specialist services provided by relatively few specialist centres e.g. burns, renal services, mental health care in secure units, transplant surgery

Question 4

What is social care?

Answer 4

Help and support provided to enable people to live as independent a life as possible and to improve quality of life
Provided in own home, residential homes, day centres
Includes social work, support services, personal care, protection, support for carers

Question 5

What was the “NHS Next Stage Review: High-Quality Care for All” important?

Answer 5

Set out 10 year plan to provide highest quality of care and service for patients in England
Led to publication of various documents e.g. NHS Constitution that have shaped monitoring and development in the NHS

Question 6

Summarise the 8 key areas of “High Quality Care for All.”

Answer 6

1. Change – locally led, patient centred and clinically driven
2. Changes in healthcare and society
3. High-quality care for patients and the public
4. Quality at the heart of everything we do
5. Freedom to focus on quality
6. High quality work in the NHS
7. The first NHS Constitution
8. Implementation

Question 7

Why was the “NHS Next Stage Review: A High-Quality Workforce” important?

Answer 7

Describes a system for workforce planning, education and training

Question 8

Why was the Health and Social Care Act (2008) important?

Answer 8

Grant Aimed to modernize and integrate Health and Social Care

Question 9

State the 4 key policy areas of the Health and Social Care Act (2008).

Answer 9

Care Quality Commission
Professional Regulation
Public Health Protection Measures
Health in Pregnancy

Question 10

State 3 reasons why the Health Act (2009) was important.

Answer 10

Improving the quality of NHS care:
Establishing a framework for the NHS Constitution

Improving the performance of NHS services:
Establishing a regime to deal with unsustainable NHS providers
Increasing powers of suspension

Improving public health:
Strengthening tobacco control
Extending adult social care complaints procedure

Question 11

Why is the NHS constitution important?

Answer 11

From January 2010 all providers and commissioners of NHS care are under a legal obligation to have regard to NHS Constitution in all their decisions
Government has legal duty to review the Constitution every 10 years

Question 12

What is the NHS Constitution?

Answer 12

Acts as a guide to:
the rights to which patients, public and staff are entitled
pledges which the NHS is committed to achieve
responsibilities which patients, public and staff owe to one another

Also sets down the 7 key principles that guide the NHS

Question 13

State the 7 Key Principles of the NHS.

Answer 13

1. NHS provides a comprehensive service, available to all
2. Access to services is based on clinical need, not ability to pay
3. NHS aspires to the highest standards of excellence and professionalism
4. The patient will be at the heart of everything the NHS does
5. NHS works across organisational boundaries and in partnership with other organisations in the interests of patients, local communities and the wider population
6. NHS is committed to providing the best value for taxpayer’s money and the most effective, fair and sustainable use of finite resources
7. NHS is accountable to public, communities and patients that it serves

Question 14

State the main NHS motto.

Answer 14

‘Patients, public and staff have helped develop this expression of values that inspire passion in the NHS and that should underpin everything it does. Individual organisations will develop and build upon these values, tailoring them to their local needs. The NHS values provide common ground for co-operation to achieve shared aspirations, at all levels of the NHS’.

Question 15

State the 6 NHS values.

Answer 15

Working together for patients
Respect and dignity
Commitment to quality of care
Compassion
Improving lives
Everyone Counts

Question 16

State the 6 C’s of the NHS?

Answer 16

Care
Compassion
Competence
Commitment
Courage
Communication

Question 17

Describe the background of the NHS and its funding and where it goes.

Answer 17

Funded centrally from national taxation
Overall NHS budget £124.7 billion (2017/18) – NHS England manages approx. £100 billion
- 60% of the budget used to pay staff
- 20% pays for drugs/supplies
- 20% spent on buildings, equipment, training costs, medical equipment, catering, cleaning

Question 18

State 3 challenges identified in 2010.

Answer 18

Rising demand and treatment costs
Need for improvement to maintain/improve standards in NHS
State of public finances (beginning of austerity measures)

Question 19

Why was ‘Equity and Excellence: Liberating the NHS’ important?

Answer 19

Coalition Government strategy for NHS July 2010 (also the basis for the changes taking place today)

Question 20

Explain the promise of “putting patients and public first” made by the Coalition government.

Answer 20

1. Patients would have:
   - shared decision making – ‘no decision about me without me’
   - access to information needed in order to make decisions about their care
   - choice of any provider, choice of consultant led-team, choice of the GP practice, choice of treatment
   - ability to rate hospitals and departments on quality of care received
   - personalised care and support for carers
   - new consumer champion ‘Health Watch England’ (within Care Quality Commission)
   - everyone to benefit, whatever their need or background

Question 21

Explain the promise of “improving healthcare outcomes “ made by the Coalition government.

Answer 21

Government’s objectives –↓mortality, ↓morbidity, ↑ safety, improve patient experience and outcomes
NHS judged against clinically relevant, evidence-based outcome measures, not process targets
culture of open information, active responsibility
NICE (National Institute for Health and Care Excellence) quality standards to inform the commissioning of NHS care
money to follow the patient
providers to be paid according to performance

Question 22

Explain the promise of “Autonomy, accountability and democratic legitimacy “ made by the Coalition government.

Answer 22

• Reforms aimed to empower professionals and providers
  devolution of power and responsibility to GPs working in consortia (commissioning groups)
  establishment of independent, accountable NHS Commissioning Board (NHS England) to lead on the achievement of health outcomes, allocate and account for NHS resources, lead on quality improvement and promoting patient involvement and choice. The Board would have an explicit duty to promote equality and tackle inequalities in access to healthcare
  increase the freedoms of foundation trusts, NHS staff to have a greater say in the future of their organisations, including as employee-led social enterprises
  all NHS trusts to become or be part of a foundation trust
  Monitor to become the economic regulator for healthcare
  Increased role of CQC as inspectorate of health and social care

Question 23

Explain the promise of “Cutting bureaucracy and improving efficiency” made by the Coalition government.

Answer 23

Need to achieve unprecedented efficiency gains (NHS not immune to the financial climate)
With the proposed changes the NHS would release up to £20 billion of efficiency savings by 2015 (reinvest to support ↑ quality)
↓NHS management costs by more than 45% over a four year period (↑resources for frontline care)
de-layer and simplify the number of NHS bodies, and radically ↓ DoH’s NHS functions

Question 24

What did reforms mean for NHS Structure?

Answer 24

↓ role of DoH
Primary Care Trusts to go (but CCGs arrived)
SHA’s abolished (but NHS Trust Development Authority arrived)
All NHS Trusts to become Foundation Trusts (or part of one)
Every GP practice had to join a Clinical Commissioning Group (CCG) CCGs replaced PCTs on 1st April 2013
£60 – 80 billion of the healthcare funds were transferred from PCTs to CCGs
New executive agency of the DoH was established = Public Health England
Health and Social Care Act 2012 – important because it provided legislation for this extensive reorganisation of the NHS

Question 25

Draw out the current structure of the NHS.

Answer 25

see document

Question 26

Describe the organisation within the NHS .

Answer 26

Secretary of State for Health and Social Care Department of Health and Social Care NHS England (operating name of NHS Commissioning Board) Public Health England Clinical Commissioning Groups Health and Wellbeing Boards Providers

Question 27

What is NHS England?

Answer 27

Provides national leadership for improving health outcomes and driving up the quality of care Oversees the operation of CCGs Allocates resources to CCGs (CCGs are responsible for approx. 2/3rds of the total NHS England budget) Commissions primary care and specialist services

Question 28

Describe Delivering NHS Services.

Answer 28

CCGs can commission any service provider that meets NHS standards and costs Provider organisations are predominantly NHS Foundation Trusts or NHS Trusts but can include private providers

Question 29

Describe how the money flows in the NHS.

Answer 29

see document

Question 30

Which organisation commissions what: a) NHS England b) CGCs c) Local authorities

Answer 30

``` a) NHS England: primary medical services dental services community pharmacy specialised services offender healthcare health care of the Armed Forces and their families b) CGCs: planned hospital care rehabilitative care urgent and emergency care most community health services mental health and learning disability services c) Local authorities: public health services ```

Question 31

State the roles and/or responsibilities of each of these ‘layers’ within the NHS: ``` Secretary of health Department of Health NHS England (strategy HQ) Clinical Commissioning Groups (CCGs) NHS improvement trusts Care Quality Commission (CQC) AHSN NHS 5-year-forward view (patient-centered) for Vanguard sites Acute Care Systems (ACSs) Sustainability and Transformation Partnerships (STPs) ```

Answer 31

Department of Health: NHS England (strategy HQ) Clinical Commissioning Groups (CCGs) hospital providers, GPs, NHS Providers of the community, ambulance providers, local authorities, NHS mental health providers, private sector, charities NHS improvement trusts - financial sorters Care Quality Commission (CQC) - investigatory body AHSN Public Health England, MHRA, Health watch, NHS Digital, NICE, Health Education England, HWB NHS 5-year-forward view (patient-centered) for Vanguard sites: Hospital, GP, Community Services, Care homes and Mental Health Services i.e. Integrated Primary and Acute Care Systems (PACs), Enhanced health care in care homes, Multispecialty Community Providers (MCPs), Acute Care Collaborations (ACCs): Urgent and Emergency Care, Dementia clinic: o The above are particularly for elderly people o Accountable Care Organisations (ACOs), Accountable Care Partnerships (ACPs) and… o Acute Care Systems (ACSs) housing, local authorities, public health, education, NHS, Social care o Sustainability and Transformation Partnerships (STPs) i.e. NHS organisations, local authorities, charities and others Vanagurd sites and 44 STPs across the UK

Question 32

State 4 groups for regulation and safeguards within the NHS.

Answer 32

Care Quality Commission NHS Improvement (brings together Monitor, NHS Trust Development Authority,  Patient Safety, the National Reporting and Learning System, the Advancing Change team and the Intensive Support Teams) Individual professional regulatory bodies Healthwatch

Question 33

State 5 proposed benefits behind all the changes to the NHS.

Answer 33

Patients would be more involved in decisions about their care GPs best placed to know what services are needed (clinical commissioning) ↓ bureaucracy (?) Acknowledged some of the work of the previous Government (including Darzi report) NHS England would be free from day-to-day political interference

Question 34

State 17 proposed concerns behind all the changes to the NHS.

Answer 34

Speed of the reforms GP consortia have to manage financial risks GPs involved in managing commissioning have less time to spend with patients May need more GPs GPs may not have the skills required (PCTs developed skills over many years) Some GPs may not want this role Would need to change the GP speciality training CCGs may need to make difficult decisions re-allocation of funds – need authority to do so Reforms were far-reaching –careful management and transition to the new structure would be needed NHS had to find savings of £20billion over next 5 years (reforms would only save £1 billion) May change the relationship between patients and their GP (patient advocate v holder of the purse strings) – loss of trust Patient choice, although good, may damage provision of some services e.g. loss of smaller or rural practices, thus disadvantaging less mobile or vulnerable patients Plans were too ambitious NHS England to be funded by (? and responsible to) DoH Reorganisation always costs money Need co-operation not competition between providers Not sure what the ‘knock-on’ effects of reforms would be

Question 35

What occurred in the NHS in 2015?

Answer 35

Election – change of Government (Conservative Government) | The policies remained basically the same

Question 36

Describe the NHS today and 4 challenges present.

Answer 36

Restructuring went ahead and is on-going ``` Challenges for the NHS remain, including: 7 day working Junior doctor’s contracts Ageing population Lifestyle-related conditions ```

Question 37

State 4 government policies of the NHS today.

Answer 37

``` Government policies include: The NHS Mandate 5 Year Forward View (2014) and Next Steps on the 5 Year Forward View (2017) NHS- Long Term Plan (2018) ```

Question 38

What is the "NHS Mandate?"

Answer 38

Sets out the Government’s direction and objectives for NHS England, as well as the budget NHS England is legally required to seek to achieve the objectives and comply with the requirements of the NHS Mandate Produced annually, it sets out the objectives for the NHS in order to achieve the long-term objectives and goals the Government has for the NHS (2020)

Question 39

State the 7 key objectives of the NHS in 2018-19.

Answer 39

1. Through better commissioning, improve local and national health outcomes, and reduce health inequalities. 2. To help create the safest, highest quality health and care service 3. To balance the NHS budget and improve efficiency and productivity. 4. To lead a step change in the NHS in preventing ill-health and supporting people to live healthier lives. 5. To maintain and improve performance against core standards. 6. To improve out-of-hospital care. 7. To support research, innovation and growth and to support the Government’s implementation of EU Exit in regards to health and care.

Question 40

Summarise the Next Steps on the NHS Five Year Forward.

Answer 40

There is welcome recognition of the need to be clear about what can and cannot be achieved within the funding made available by the government In line with the new mandate for the NHS in England, NHS England has decided to give lower priority to the target that patients waiting for less urgent diagnosis and treatment should be seen within 18 weeks In reality, the growing number of patients on waiting lists means that this target is already difficult to deliver, a development that has been widely interpreted as evidence of declining NHS standards Patients waiting for routine surgery will be dismayed at the prospect of long waits, and some may challenge the NHS for failing to deliver a commitment enshrined in the NHS Constitution

Question 41

What were and are 'vanguards' within the NHS?

Answer 41

= organisations coming together to try and make a plan to improve patient's lives (and professionals) Vanguards were introduced in 2015 as part of the NHS Five Year Forward View.  The 50 chosen vanguards are tasked to develop new care models and potentially redesign the health and care system It is envisaged that this could lead to better patient care, service access and a more simplified system. 

Question 42

Describe 'sustainability and Transformation Plans (STPs)' in the NHS.

Answer 42

Also a result of the NHS Five Year Forward View. The purpose of STPs is to help ensure the health and social care services in England are built around the needs of local populations They are five-year plans covering all aspects of NHS spending in England.

Question 43

State the 3 aspects of NHS spending in England.

Answer 43

improving quality and developing new models of care improving health and wellbeing improving the efficiency of services

Question 44

What was the NHS Long-term Plan (2018) developed for?

Answer 44

Developed to make the NHS fit for the future

Question 45

Summarise the NHS Long-term Plan (2018) in 3 points.

Answer 45

Making sure everyone gets the best start in life Delivering world-class care for major health problems Supporting people to age well