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Understanding the Healthcare System

Decisions over health funding and policies in Scotland, Wales and Northern Ireland are taken by their respective Governments. As a result, the structure of the NHS varies between the different countries of the UK. Please click the tabs below for an outline of each healthcare system.

The Healthcare System

England

The Government’s Department for Health and Social Care sets some key objectives for the NHS and provides its funding.

NHS England is the national organisation that oversees the commissioning (purchasing and planning) of health services. It is also currently directly responsible for commissioning inpatient eating disorder services, along with inpatient child and adolescent mental health services.

From April 2020, groups of service providers (each led by an NHS Trust) began taking over responsibility for managing the budgets of inpatient eating disorder services as well as providing the care. These groups are known as ‘Provider collaboratives’. These changes have the potential to incentivise and support greater investment in early intervention and intensive day patient and home-based forms of treatment.

Clinical Commissioning Groups (CCGs) have legal responsibilities to understand the needs of local people and improve their health. CCGs commission GP surgeries and most mental health services. They do this by agreeing contracts with providers (mainly NHS Trusts) and monitoring that they are providing the services as planned.

Each region of England is home to several separate NHS organisations, which are involved in planning and providing services. Recent years have seen a more collaborative approach, bringing together these organisations into Sustainability and Transformation Partnerships (STPs).The range of NHS organisations that comprise STPs include Clinical Commissioning Groups (CCGs), as well as NHS Trusts and other providers of services. STPs also include representation from local authorities, the voluntary sector and others. Those STPs that have been the most effective at joining up care have graduated to become classified as ‘Integrated Care Systems’ (ICS). Increasingly it is STPs and ICSs taking key decisions about the future of eating disorder services.

Patient Advice and Liaison Services (PALS)which are based in hospitals, can provide confidential information and support to help resolve concerns or problems with local NHS care. Each area of England has a local branch of Healthwatch. Local Healthwatch organisations are responsible for finding out the key priorities and concerns of local people and communicating these to NHS leaders. They can also help people find information about local NHS services.

Other key national bodies include:

  • The Care Quality Commission (CQC): An independent regulator that conducts inspections of health and social care services. Local Healthwatch branches share their findings with the national body Healthwatch England, which is part of CQC.
  • The National Institute for Health and Care Excellence (NICE): Publishes clinical guidelines and quality standards that set out the treatment and support patients and carers should receive in England. In some cases, they are adopted as benchmarks of good practice by the devolved Governments of Scotland, Wales, and Northern Ireland.
  • Health Education England (HEE): Responsible for coordinating NHS training and planning around staff recruitment and retention.
Wales

The Welsh Government’s Department for Health and Social Services sets the strategy for the NHS in Wales. It allocates funding to health boards and monitors their performance.

Wales is divided into seven health boards, which are responsible for planning and providing NHS services for their local populations. There are a small number of exceptions where services can be provided by a neighbouring health board.

Highly specialised services, including inpatient mental health services, are commissioned (purchased and planned) by a national committee called the Welsh Health Specialised Services Committee (WHSSC), which includes representation from each of the Health Boards.

Each of the areas covered by a health board has a Community Health Council (CHC). Community Health Councils are independent organisations that encourage and support people to help improve the design and delivery of NHS services in their area. They do this by bringing together local NHS leaders, those who inspect and regulate the NHS and those who use it. CHCs also provide an advocacy service to help patients or their representatives to access information, as well as supporting them to raise concerns with the relevant NHS organisation for further investigation.

The work of the following nationwide health organisations in Wales is also very important for the success of our campaigning:

  • Healthcare Inspectorate Wales – an independent regulator that carries out inspections of NHS and independent sector health services.
  • Health Education and Improvement Wales – responsible for overseeing education, training and development of the NHS workforce, including through improving recruitment and retention.
  • Public Health Wales – provides advice and services to Government, the NHS and local authorities on the promotion of good health and wellbeing and the reduction of health inequalities.
Scotland

The Scottish Government sets the strategy for the NHS in Scotland. It allocates funding to health boards and monitors their performance.

Scotland is divided into fourteen health boards which are responsible for planning and providing NHS services for their local populations. There are some exceptions where services are provided by a neighbouring health board.

Health and Social Care Partnerships (HSCPs) bring together health boards and local authorities with the aim of achieving a joined-up approach to the planning and delivery of NHS and social care services.

The Scottish Health Council (SHC) helps patients and the public have their say on the NHS in Scotland. It works with NHS boards to help them engage with local people. Each health board is home to a local office of the SHC. The Citizen Advice Bureau’s Patient Advice and Support Service (PASS) can provide free and impartial help for people wishing to make a complaint.

The work of the following nationwide health organisations in Scotland is also very important for the success of our campaigning:

  • Healthcare Improvement Scotland – conducts inspections of NHS and independent sector health services, and publishes guidance for health professionals about evidence-based treatments through the Scottish Intercollegiate Guidelines Network (SIGN).
  • NHS Education for Scotland (NES) – responsible for overseeing education, training and development of the health and social care workforce, including through improving recruitment and retention.
  • NHS Health Scotland – provides information and advice on the promotion of good health and wellbeing, including the reduction of health inequalities.
  • The Mental Welfare Commission for Scotland - a ‘watchdog’ of NHS services which conducts research and publishes reports and reviews about NHS treatment. It also publishes information for service-users and carers.
Northern Ireland

In Northern Ireland, the NHS Is referred to as HSC (Health and Social Care Services). This is because, unlike the other countries of the UK, both health and social care services are provided by the same organisations. The Department of Health, Social Services and Public Safety for Northern Ireland (DHSSPS) has overall responsibility for health and social care.

The Government allocates funding to the Health and Social Care Board (HSCB), which is responsible for commissioning (purchasing and planning) health and social care services. It does this through agreeing contracts with Northern Ireland’s five Health and Social Care (HSC) Trusts and monitoring their performance, in addition to family health services provided by GPs, dentists, opticians and community pharmacists. The HSCB is made up of five Local Commissioning Groups (LCGs) which cover the same geographical areas as the five Health and Social Care Trusts.

HSC Trusts provide mental health services, as well as providing hospitals, residential homes and other health and social care services.

The Patient and Client Council (PCC) helps patients and the public have their say on health and social care services in Northern Ireland. The PCC has a local office in each of the five Health and Social Care (HSC) Trusts. The PCC also provides an advocacy service that can help patients or their representatives to access information as well as supporting them to raise concerns with the relevant HSC organisation for further investigation.

The work of the following nationwide health organisations in Northern Ireland is also very important for the success of our campaigning:

  • Regulation and Quality Improvement Authority (RQIA) – an independent regulator for health and social care services which carries out inspections and reviews.
  • Public Health Agency (PHA) – responsible for promoting good health and wellbeing, including by supporting efforts to reduce health inequalities. It also helps shape the plans of the Health and Social Care Commissioning Board (HSCB).