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Understanding the system

The UK Parliament is made up of three parts: the House of Commons, the House of Lords and the Monarch. They are responsible for creating laws, representing the views of people across the country and keeping a check on the work of the Government.

UK Parliament

House of Commons

There are 650 Members of Parliament in the House of Commons. Members of Parliament or MPs are individuals voted for by the people in their area in the democratic process of an election. Each MP represents a different area of the UK called a constituency. The people living in this area are called Constituents. Every Constituent who is 18 or over has a right to vote for who they want to hold the seat for their constituency, i.e. represent them in Parliament. These votes for all constituencies take place in a general election, held every five years, although sometimes general elections can be called early. If an MP leaves before the end of their term, a by-election will be held for that constituency.

Most MPs belong to a political party, a group of people who have similar ideas about how they want to run the UK. The main parties in the UK are the Conservative Party, the Labour Party, the Liberal Democrats, the Scottish National Party, Plaid Cymru, the Democratic Unionist Party, Sinn Féin and the Green Party. The Government is formed by the party that has the most MPs with seats in the House of Commons after an election (this needs to be a majority – at least 326 seats). The Government is in charge of running the UK. It is made up of the Prime Minister and the MPs and Lords they choose to make up their Cabinet. The Cabinet are Ministers who are responsible for different areas like transport, health and education. It works a little like the running of a school: there is the headteacher (Prime Minister), the heads of department (Cabinet Ministers) and the teachers (MPs) who ensure that it all works well for the students who attend (UK population).

The party with the next highest number of seats becomes the Opposition. Much like the Government selecting Ministers for each area, the opposition select their own Shadow Ministers for each department, and the leader of that party is known as the Leader of the Opposition. Their role is to scrutinise their corresponding Government Ministers, develop alternative policies and hold them to account. MPs who hold Government or Opposition roles sit on the front bench in the House of Commons. MPs from all parties who do not hold specific roles sit behind, so are known as Backbenchers.

House of Lords

There are 800 members of the House of Lords. Many Lords have worked in politics, but many have done other jobs. There are doctors, soldiers, scientists, writers, teachers, police officers, sportspeople and many other professional people. They are chosen for their knowledge and experience, so they can use their skills to ask questions, debate important issues and examine and suggest changes to plans for new laws. They can use this professional knowledge and experience to check that the detail in plans for new laws makes sense, is fair, and will work for different groups of people. If they think a plan for a new law could be improved they suggest changes. Most are called ‘Life Peers’ as they are given membership for their lifetime.

The Monarch

The role of the Monarch (the King or Queen) in the UK Parliament is mainly ceremonial. They meet the Prime Minister once a week to discuss what is going on in Parliament, sign any new laws and attend the state opening of Parliament each year.

What Parliament does

In the House of Commons Chamber, important topics are debated and laws are discussed. This is where Backbench MPs and the Opposition can challenge the work of the Government.

A new idea for a law is called a Bill. These can start in either the House of Lords or the House of Commons. Both these parts of Parliament have to look at the bill and there can be some back and forth discussion before the final law is agreed. Once agreed, the Monarch is asked to pass the new law – this is called Royal Assent. All parts of parliament must agree on the law before it can be put in place. Legislation is another term that refers to a law or some aspect of the law. A policy is a declaration of the Government's plans and intentions relating to an issue or cause.

Green Papers are documents produced by the Government. The aim of this document is to allow people both inside and outside Parliament to give the department feedback on its policy or legislative proposals, in a process known as a consultation.

White Papers are policy documents produced by the Government that set out their proposals for future legislation. These can be based on a previous Green Paper, though is not always. This provides a basis for further consultation and discussion with interested or affected groups and allows final changes to be made before a Bill is formally presented to Parliament.

Select Committees are made up of MPs or Members of the House of Lords. They examine the spending, administration and policy of Government departments. They also look at anything else that Parliament decides needs to be looked at, such as a problem happening in the country at that time. Select Committees can ask people from the Government to answer questions, and ask people outside of Parliament to share views and ideas too. They then tell Parliament what they found out and what they think needs to change, and produce a publicly available report.

All-Party Parliamentary Groups (APPGs) bring together MPs from across all parties in Parliament who have a special interest in a particular issue or topic. During meetings, MPs discuss improvements to policy and may hear from those affected by the issue. In 2019, Beat provided support and administration for the setup of an APPG on eating disorders. A particular focus of this group is improving access and treatment for people affected by eating disorders and measures that support prevention and early intervention. Beat is currently the secretariat for the APPG – this means we help to coordinate the group’s activities, arrange meetings and keep track of members.

Devolution to Scotland, Wales and Northern Ireland

The UK Parliament is the main law-making body, but some powers have been ‘devolved’ to the Scottish Parliament, the Welsh Parliament (Senedd Cymru) and the Northern Ireland Assembly. This means that those institutions have the power to make their own laws about some issues, including education and health. As healthcare is a devolved issue, this means that decisions about this are made by each country’s own Parliament or Assembly.

In Scotland, a Member of Scottish Parliament (MSP) sits in the Scottish Parliament.

In Wales, a Member of the Senedd (MS) sits in the Welsh Parliament (more likely to be known as the Senedd Cymru in Wales).

In Northern Ireland, a Member of the Legislative Assembly (MLA) sits in the Northern Ireland Assembly.

Contacting your local representative

Your local politician is your voice in your Parliament or Assembly. It’s important to let them know about issues that are affecting you and others in your area. You can find out more about engaging with them here.

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. NHS England is also responsible for coordinating NHS training and workforce planning.

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.

Integrated Care boards (which have recently replaced Clinical Commissioning Groups) are statutory NHS organisations which are responsible for understanding the needs of the populations they serve, managing the budgets given to them by NHS England and arranging the provision of services in the area by commissioning providers (mainly NHS Trusts) to deliver services.

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) and Integrated Care Systems (ICSs).The range of NHS organisations that comprise STPs/ICSs include Clinical Commissioning Groups (CCGs), as well as NHS Trusts and other providers of services. These partnerships also include representation from local authorities, the voluntary sector and others. 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.
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).