As a public service funded by the taxpayer, the NHS is accountable to Government Ministers, who in turn are accountable to Parliament.
Different arrangements exist in different parts of the United Kingdom - both in Government responsibilities for the NHS and how that responsibility is discharged.
The NHS in England is the responsibility of the Secretary of State for Health who is a member of the cabinet. The current Secretary of State is the Rt Hon Frank Dobson MP, heading the Department of Health.
The Secretary of State and his team of Ministers set overall health policy in England, including policy for the NHS. The NHS Executive, which is a part of the Department of Health, acts as the HQ of the NHS in England and is responsible for translating policy into practice, setting strategic targets for the NHS and monitoring performance. The Executive has eight regional offices which in turn monitor the performance of the health authorities in their areas. The work of the NHS Executive is lead by a Chief Executive, currently Alan Langlands.
A Government policy statement in December 1997 set out a series of proposed changes to the NHS in England. "The New NHS. Modern. Dependable". The statement (called a "White Paper") sets out proposals for modernising the NHS to meet the wishes of patients for an up to date, quicker and more responsive service. The white paper sets out an ambitious and far reaching programme to do just this, with a target of a ten year programme to modernise the NHS.
The NHS in Wales is the responsibility of the Secretary of State for Wales, currently the Rt Hon Ron Davies who is a member of the Cabinet. His department, the Welsh Office, is very largely based in Cardiff. He is assisted by a Parliamentary Secretary of State, Mr Win Griffiths, who has responsibility for health.
In Wales there are currently five health authorities, 29 Trusts, and two special health authorities (the Welsh Common Services Authority and the Health Promotion Authority for Wales). The health authorities' role includes quantifying the health care needs of their area and commissioning the necessary care accordingly, supporting the contractor professions, protecting public health, and responding to the views of people and organisations in their area. NHS Trusts are charged with providing services and operate hospitals, community health service, ambulance services and other health facilities in accordance with contracts they have with health authorities.
The White Paper 'Putting Patients First' was published by the Welsh Office on 15 January 1998 and establishes a new direction for the NHS in Wales. It sets out proposals for replacing the internal market with a system of integrated care, underpinned by a philosophy of partnership, and driven by performance.
During 1999 practically all the health responsibilities of the Welsh Office will pass to the National Assembly for Wales. The Health Promotion Authority for Wales and parts of the Welsh Health Common Services Authority will also become part of the Assembly. Proposals to reconfigure and rationalise the NHS Trusts in Wales are presently being pursued with the objective of the new structure becoming operational in April 1999.
In Northern Ireland the Department of Health and Social Services (DHSS) is required, under the provisions of the Health and Personal Social Services (Northern Ireland) Order 1972, to secure the provision of an integrated service designed to promote health and social welfare of the population.
Part of this provision is the Health Services in Northern Ireland which is managed by the Health and Social Services Executive (HSSE).
The Health and Social Policy Group (HSPG) of the DHSS is responsible for promoting wider health and social gain . It sets the overall strategy for health and personal social services; promotes voluntary activity and community development in Northern Ireland; takes the lead in targeting health and social need; and is responsible for health promotion and protection, developing social policy and social legislation.
The strategy of the DHSS has three main aims:
- to promote health and social wellbeing
- to target health and social need
- to secure and improve the provision and delivery of health and social services
Health and Social Services Executive
The Health and Social Services Executive is the Northern Ireland counterpart to the NHS Executive in England. Its primary purpose is to secure improvements to the health and social wellbeing of people in Northern Ireland. Its main functions are:
- To provide leadership, direction and support to the HPSS in Northern Ireland
- To set and ensure the achievement of specific objectives and targets for the HPSS in accordance with national and regional policies and priorities
- To monitor the performance of HPSS in assessing need and improving health And social wellbeing of the population
- To allocate resources and ensure that they are used effectively, efficiently and economically, in accordance with the required standards of public accountability
- To promote the managerial environment necessary to achieve these objectives
- To provide advice, information and support to Ministers relating to the management and performance of the HPSS
The HSSE is headed by a Chief Executive who is supported by six directors.
Health and Social Services Boards
There are four Health and Social Services Boards in Northern Ireland. They act as agents of the DHSS in planning, commissioning and purchasing health and social services for residents in their areas - functioning in a similar role to Health Authorities in England.
Each Board has a non-executive chairman, six executive and six non-executive members. The chairman and non-executive members are appointed by the Minister with the approval of the Secretary of State. By statute two of the executive members are the chief executive/general manager and director of finance.
As commissioners and purchasers, Boards are required to plan, secure and pay for the services needed to meet the health and social care needs of their population. In deciding which services are needed, the Boards assess the population's health and social care needs by collecting information about patterns of death, illness and community care needs and by consulting local people. They also liase with GPs and statutory and voluntary agencies to build up a picture of the health and social care needs of their residents.
Health and Social Services Trusts
The HSS Trusts are the providers of health and social services. They are responsible for the management of staff and services at hospitals and other establishments previously managed or provided by Boards. The Trusts control their own budgets and, although managerially independent of Boards, they are accountable to the HSSE.
There are 20 Trusts in Northern Ireland. It is the only part of the UK which, because of the integrated health and social services, has Trusts based solely on the delivery of community health and social services.
Each Trust is managed by a Board of Directors which contains up to five non-executive members and a non-executive chairman, who are appointed by the DHSS with the approval of the Secretary of State and five executive members who are employees of the Trust.
A Paper - broadly following the policy set out in the White Papers in the rest of the UK but taking into account the structure of health and social services in Northern Ireland - is due to be published shortly.
Overall responsibility for the National Health Service in Scotland rests with the Secretary of State for Scotland, with the NHS Management Executive within The Scottish Office Department of Health responsible for health service policy and central management. The Management Executive sets national objectives and priorities, agrees corporate contracts with area Health Boards and monitors their performance.
Health Boards are responsible for planning and commissioning hospital and community health services for the people who live within their area. Health Boards are also responsible for strategic management of the primary care services provided by GPs, dentists, community pharmacists and opticians, who are independent contractors. There are 15 Health Boards covering the whole of Scotland (12 mainland and 3 island Boards).
There are 46 NHS Trusts in Scotland responsible for providing hospital and/or community services in a particular area, under contract to Health Boards and others, in the best interests of patient care; and one national Trust responsible for the Scottish Ambulance Service. Each Trust is accountable to the Secretary of State via the Management Executive.
There are also a number of other national organisations responsible for associated services and include the Common Services Agency, the Health Education Board for Scotland, the State Hospitals Board for Scotland. The patients' and public's interests in the NHS are represented by 16 Local Health Councils (one for each Health Board area except for the Western Isles which has two).
New proposals for the National Health Service in Scotland where set out in the Government's White Paper: Designed to Care. This announced that the 15 Health Boards would remain but that there would be a smaller number of Trusts of two types: acute hospital Trusts and primary care Trusts. The Scottish Ambulance Service is to become a special Health Board. Subject to legislation these changes will take effect from 1 April 1999.