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Learn the lingo series: "NHS England"

Written by Ali Chakera on 30 September 2012. Modified on 06 August 2013. Hits: 6741

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What?
NHS England (formerly known as the NHS Commissioning Board) is an independent national organisation responsible for the day-to-day running of the NHS. As the body tasked with ensuring the NHS delivers better outcomes for patients, it also provides leadership for the new system and is
accountable for the delivery of improvements against the objectives set out in the NHS Mandate.

As well as overall leadership, NHS England will be directly responsible for approximately £25bn worth of commissioning to cover specialised services, primary care and military and prison services. It will also be accountable for Clinical Commissioning Groups (CCGs) who will have responsibility for commissioning a further £65bn of healthcare across England. NHS England will performance-manage all 211 CCGs to ensure they are financially stable and achieving the outcomes required of them.

NHS England is led by the incumbent Chief Executive of the NHS, Sir David Nicholson. He heads a team of seven National Directors:

  • Medical Director - Professor Sir Bruce Keogh
  • Chief Nursing Officer - Jane Cummings
  • Director of Policy - Bill McCarthy
  • Director for Patients and Information - Tim Kelsey
  • Director of Commissioning Development - Dame Barbara Hakin
  • Chief Financial Officer - Paul Baumann
  • Director of Human Resources - Jo-Anne Wass

Alongside the National Directors, several Non-Executive Directors sit on the board. They are tasked with providing expertise and advice from outside the NHS and represent a number of different industries, such as finance, retail and the voluntary and public sectors.

NHS England employs 3,500 staff across several bodies:
National office:                    Based in Leeds, they employ 800 people.
Commissioning Regions:   4 regions based in North, Midlands & East, South and London, employing 200 people.
Local Area Teams (LATs): 27 LATs responsible for commissioning primary care services, including pharmacy services; assessing CCG performance;
managing primary care contracts; and managing NHS England’s local relationships. In addition, 10 of the 27 will be responsible for
specialised commissioning. They are managed by the Commissioning Regions and there are an estimated 8 CCGs per LAT on average.

Why?
The creation of an ‘NHS Commissioning Board’ was first proposed in the Government White Paper, Equity and Excellence: Liberating the NHS, published in July 2010. This laid the foundations for a national body, now known as ‘NHS England’, to assume those functions held by PCTs which could not be provided by CCGs such as primary care commissioning. The White Paper also set out the statutory position of NHS England as a function independent from the Department of Health (DH) in order to limit the powers of Government Ministers in day-to-day decisions about the NHS.

In the Government’s original plans, CCGs would have been responsible for spending the vast majority of the commissioning budget; however, the number of services defined as specialised has since increased. The decision to transfer a number of specialised services previously under the remit of PCTs, such as chemotherapy, to NHS England was taken to eliminate variation in standards of care and access to treatment.

How?
The DH issues the ‘Mandate’ which sets out those areas in which the Government expects NHS England to deliver improvement over a set period; the current Mandate is in place until 2015. NHS England’s progress in delivering the Mandate will be measured through a wide range of indicators set out in the NHS Outcomes Framework, which is agreed by NHS England with the DH. To reflect the move from disease-specific quality measurements to a focus on outcomes across broader areas, the framework sets out high-level national outcomes across five domains. For each domain, there are a small number of overarching indicators followed by a number of specific improvement areas.

There are National Leads for each of the five domains who are tasked with coordinating and leading NHS England’s work to improve outcomes in that domain. The National Leads are supported by 21 National Clinical Directors, who provide expert advice and research on specific conditions and
diseases across the domains.

The five domains and their National Leads, who report to the Medical Director, are:

  • Preventing people from dying prematurely (Professor Sir Mike Richards)
  • Enhancing quality of life for people with long-term conditions (Dr Martin McShane)
  • Helping people to recover from episodes of ill Health or following injury (Professor Keith Willet)
  • Ensuring that people have a positive experience of care (Neal Churchill)
  • Treating and caring for people in a safe environment and protecting them from avoidable harm (Dr Mike Durkin)

To help achieve the required outcomes, NHS England will use tools such as the CCG Outcome Indicator Set (formerly known as the Commissioning Outcomes Framework) and NICE Quality Standards to ensure outcomes are being achieved at the local level by CCGs. CCGs will be incentivised to do this through payment mechanisms such as the Quality and Outcomes Framework (QOF) and Commissioning for Quality and Innovation (CQUIN).

The Government will publish a yearly assessment of NHS England’s performance in delivering the Mandate. Progress will be measured using the key performance indicators set out in the NHS Outcomes Framework and the process will include feedback from CCGs, local councils, patients and
other stakeholders. However, it is not yet clear exactly what action the Government will take if the NHS England is judged to be failing to deliver on its objectives.

Editor's note: This article has been generated from information provided by Sanofi Diabetes. Please also note that the article is not regularly monitored and may become less accurate over time as things evolve.

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