NHS England, officially the NHS Commissioning Board, is an executive
non-departmental public body
In the United Kingdom, non-departmental public body (NDPB) is a classification applied by the Cabinet Office, Treasury, the Scottish Government and the Northern Ireland Executive to public sector organisations that have a role in the process of n ...
of the
Department of Health and Social Care
The Department of Health and Social Care (DHSC) is a department of His Majesty's Government responsible for government policy on health and adult social care matters in England, along with a few elements of the same matters which are not otherwis ...
. It oversees the budget, planning, delivery and day-to-day operation of the commissioning side of the
National Health Service in England
The National Health Service (NHS) is the publicly funded healthcare system in England, and one of the four National Health Service systems in the United Kingdom. It is the second largest single-payer healthcare system in the world after the ...
as set out in the
Health and Social Care Act 2012
The Health and Social Care Act 2012c 7 is an act of the Parliament of the United Kingdom. It provided for the most extensive reorganisation of the structure of the National Health Service in England to date.''BMJ'', 2011; 342:d408Dr Lansley's Mon ...
.
It directly commissions NHS
general practitioners, dentists, optometrists and some specialist services. The Secretary of State publishes annually a document known as the ''
NHS mandate
The Health and Social Care Act 2012 established NHS England and provides that the Secretary of State is to publish, annually, a document known as the NHS mandate which specifies the objectives which the Board should seek to achieve. National Healt ...
'' which specifies the objectives which the Board should seek to achieve. National Health Service (Mandate Requirements) Regulations are published each year to give legal force to the mandate.
In 2018 it was announced that the organisation, while maintaining its statutory independence, would be merged with
NHS Improvement
NHS Improvement (NHSI) was a non-departmental body in England, responsible for overseeing the National Health Service's foundation trusts and NHS trusts, as well as independent providers that provide NHS-funded care. It supported providers to ...
, and seven "single integrated regional teams" would be jointly established.
History
![Amanda Pritchard](https://upload.wikimedia.org/wikipedia/commons/f/f9/Amanda_Pritchard.gif)
NHS England is the operating name of the NHS Commissioning Board and, before that, the NHS Commissioning Board Authority. It was set up as a
special health authority
A special health authority is a type of NHS body which provide services on behalf of the National Health Service in England. Unlike other types of trust, they operate nationally rather than serve a specific geographical area.
They are a type of " ...
of the
NHS
The National Health Service (NHS) is the umbrella term for the publicly funded healthcare systems of the United Kingdom (UK). Since 1948, they have been funded out of general taxation. There are three systems which are referred to using the " ...
in October 2011 as the forerunner to becoming a non-departmental body on 1 April 2013.
It was renamed NHS England on 26 March 2013, although its legal name remains the NHS Commissioning Board.
Sir
David Nicholson, who became Chief Executive at the establishment of the Board, retired at the end of March 2014 and was replaced by
Simon Stevens
Simon Laurence Stevens, Baron Stevens of Birmingham, (born 4 August 1966) is a British public policy adviser, former CEO, and independent member of the UK House of Lords. He served as the eighth Chief Executive of the National Health Service ...
. One of Stevens' first acts was to announce a restructure of the 27 area teams, in response to a requirement to reduce running costs, which would reduce staffing by around 500. The 27 teams outside London were reduced to 12 in 2015.
Amanda Pritchard
Amanda Kate Pritchard (born May 1976) is a British healthcare official and public policy analyst who has been the Chief Executive of NHS England since 1 August 2021. Pritchard previously served as chief operating officer of NHS England and as chi ...
, the Chief Operating Officer of NHS England, was promoted to Chief Executive on 1 August 2021.
System management
NHS England produced a planning document – the
Five Year Forward View
The Five Year Forward View was produced by NHS England in October 2014 under the leadership of Simon Stevens as a planning document.
Publication and reception
It received praise for brevity, being only 39 pages, and lacking the illustrations wh ...
– in October 2014 which envisaged development of new models to suit local needs. In conjunction with the other central regulators, the organisation established what is called a "success regime" in south and mid Essex, North Cumbria and north east and western Devon in June 2015. It was intended to tackle "deep rooted and systemic issues that previous interventions have not tackled across
whole health and care economy".
In 2016 it organised the geographical division of England into 44
sustainability and transformation plan
In England, a sustainability and transformation plan (STP) is a non-statutory requirement which promotes integrated provision of healthcare, including purchasing and commissioning, within each geographical area of the National Health Service. The ...
areas, with populations between 300,000 and 3 million. These areas were locally agreed between
NHS Trust
An NHS trust is an organisational unit within the National Health Services of England and Wales, generally serving either a geographical area or a specialised function (such as an ambulance service). In any particular location there may be several ...
s, local authorities and
clinical commissioning group
Clinical commissioning groups (CCGs) were NHS organisations set up by the Health and Social Care Act 2012 to organise the delivery of NHS services in each of their local areas in England. On 1 July 2022 they were abolished and replaced by Integra ...
s (CCGs). A leader was appointed for each area, who is to be responsible for the implementation of the plans which are to be agreed by the component organisations. They will be "working across organisational boundaries to help build a consensus for transformation and the practical steps to deliver it".
In April 2017 it introduced a capped expenditure process, applied to NHS commissioners and providers in the 13 areas across England with the largest budget deficits. It is intended to reduce their spending by around £500 million, and health leaders were told to "think the unthinkable".
In 2022 there were seven regional teams and 10,640 full time equivalent staff.
Funding of clinical commissioning groups
NHS England allocates funding (£69.5 billion in 2016/2017) to CCGs in accordance with a funding formula. Until 2016, progress towards the amount indicated by the formula from the historical allocation was slow, and CCGs which were above their allocation did not suffer a reduction. From April 2016, however, CCGs with more than 10 per cent above their fair share were to receive "flat cash" – an effective reduction. This would also ensure than no CCG was more than 5 per cent below its target allocation in 2016/2017.
Operational pressures escalation levels framework
In October 2016 it introduced the Operational Pressures Escalation Levels (OPEL) system for the management of operational difficulties in English hospitals, replacing the system of red and black alerts which was locally defined. OPELs range from 1 (normal) to 4 (a major crisis requiring external intervention either regionally or nationally). This is intended, among other things, to enable comparisons of trends over time and between areas.
Response to 2020 pandemic
In view of the
coronavirus pandemic
The COVID-19 pandemic, also known as the coronavirus pandemic, is an ongoing global pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The novel virus was first identified ...
, the
Secretary of State for Health and Social Care
The secretary of state for health and social care, also referred to as the health secretary, is a secretary of state in the Government of the United Kingdom, responsible for the work of the Department of Health and Social Care. The incumbent ...
directed the NHS Commissioning Board to buy services from the private sector, thereby bypassing CCGs. The Exercise of Commissioning Functions by the NHS Commissioning Board (Coronavirus) Directions 2020 came into force on 20 March 2020, and were revised to widen the definition of independent providers on 27 March. The directive also allows NHS England to exercise functions normally carried out by CCGs, as the Board deems appropriate. The direction will be in place until the end of 2020.
Primary care
Applications by GPs to reduce their catchment area are dealt with by NHS England.
In November 2014, Mr Justice Popplewell declared that NHS England "has acted unlawfully by reason of its failure to make arrangements for the involvement of patients in primary care commissioning decisions as required by the National Health Service Act 2006". The case involved the decision to scrap the minimum practice income guarantee. Richard Stein, a partner at
Leigh Day
Martyn Day is a British solicitor specializing in international, environmental and product liability claims who founded – and is the Senior Partner of – the law firm Leigh Day. He was a director of Greenpeace Environmental Trust, having stepp ...
, said the declaration could mean that patients would have to be involved in discussions on changes to the GP contract.
NHS England awarded a four-year contract to
Capita
Capita plc, commonly known as Capita, is an international business process outsourcing and professional services company headquartered in London.
It is the largest business process outsourcing and professional services company in the United K ...
to become sole provider of administrative services including payment administration, management of medical records, and eligibility lists for practitioners for GPs, opticians and dentists across the UK in June 2015.
Information technology
The organisation was reported to be developing a strategy to support the use of personal health records in June 2015. This, it is hoped, could achieve up to £3.4 billion in annual efficiency savings by 2020. In April 2016 it published an index of digital maturity, where each of the 239 NHS trusts assessed its own "readiness", "capabilities" and "enabling infrastructure".
In 2018 the
NHS app was unveiled, with public backing from
Matt Hancock
Matthew John David Hancock (born 2 October 1978) is a British politician who served as Minister for the Cabinet Office and Paymaster General from 2015 to 2016, Secretary of State for Digital, Culture, Media and Sport from January to July 201 ...
, who presented it as the key to a radical overhaul of NHS technology.
The
NHS Long Term Plan
The NHS Long Term Plan, also known as the NHS 10-Year Plan is a document published by NHS England on 7 January 2019, which sets out its priorities for healthcare over the next 10 years and shows how the NHS funding settlement will be used. It was p ...
set a target for all secondary care providers to move to digital records by 2024, which "will cover clinical and operational processes across all settings, locations and departments and be based on robust, modern IT infrastructure services for hosting, storage, networks and cyber security.”
Specialised commissioning
Specialised services are those provided in relatively few hospitals and accessed by comparatively small numbers of patients, but with catchment populations of usually more than one million. These services tend to be located in specialised hospital trusts that can recruit a team of staff with the appropriate expertise. NHS England is responsible for commissioning £19.3 billion of specialised services in 2021-2 and for dealing with
Individual Funding Requests in respect of the specialist services it commissions. There are proposals to move some of this commissioning to
integrated care system
In England, an integrated care system (ICS) is a statutory partnership of organisations who plan, buy, and provide health and care services in their geographical area. The organisations involved include the NHS, local authorities, voluntary and cha ...
s. The
Shelford Group
The Shelford Group is a collaboration of ten of the largest teaching and research NHS hospital trusts in England. The ten members collectively employ over 140,000 people and account for over £12.5 billion of the NHS budget.
The member organisat ...
expressed concerns in May 2022 about services "where the numbers and evidence base supports the planning and provision of care being done at a population size larger than a typical ICS footprint.”
In 2015 there was criticism of delays in deciding on a policy for the prescription of
Everolimus
Everolimus, sold under the brand name Afinitor among others, is a medication used as an immunosuppressant to prevent rejection of organ transplants and as a targeted therapy in the treatment of renal cell cancer and other tumours.
It is the 40 ...
in the treatment of
tuberous sclerosis
Tuberous sclerosis complex (TSC) is a rare multisystem autosomal dominant genetic disease that causes non-cancerous tumours to grow in the brain and on other vital organs such as the kidneys, heart, liver, eyes, lungs and skin. A combination ...
. Twenty doctors addressed a letter to the board in support of the charity Tuberous Sclerosis Association saying "around 32 patients with critical need, whose doctors believe everolimus treatment is their best or only option, have no hope of access to funding. Most have been waiting many months. Approximately half of these patients are at imminent risk of a catastrophic event (renal bleed or kidney failure) with a high risk of preventable death."
It authorises and pays for treatment of
narcolepsy
Narcolepsy is a long-term neurological disorder that involves a decreased ability to regulate sleep–wake cycles. Symptoms often include periods of excessive daytime sleepiness and brief involuntary sleep episodes. About 70% of those affec ...
with
sodium oxybate
Sodium oxybate, sold under the brand name Xyrem among others, is a medication used to treat two symptoms of narcolepsy: sudden muscle weakness and excessive daytime sleepiness. It is used sometimes in France and Italy as an anesthetic given i ...
by means of individual funding requests on the basis of exceptional circumstances. In May 2016 the High Court ordered NHS England to provide funding to treat a teenager with severe narcolepsy. The judge criticised their “thoroughly bad decision” and “absurd” policy discriminating against the girl when hundreds of other NHS patients already receive the drug. The Department of Health is also paying for the treatment of people whose narcolepsy was caused by the swine flu vaccine
Pandemrix
Pandemrix is an influenza vaccine for influenza pandemics, such as the 2009 flu pandemic. The vaccine was developed by GlaxoSmithKline (GSK) and patented in September 2006.
The vaccine was one of the H1N1 vaccines approved for use by the Europea ...
in 2009–10 by means of private prescriptions outside the National Health Service.
In May 2022 it produced guidance that said 65 of the 154 services they commissioned were ready and suitable to be devolved to the
integrated care system
In England, an integrated care system (ICS) is a statutory partnership of organisations who plan, buy, and provide health and care services in their geographical area. The organisations involved include the NHS, local authorities, voluntary and cha ...
s. It is expected that most will be jointly commissioned with their neighbours, rather than on their own.
Arbitration
The organisation's responsibilities include arbitration in disputes between
clinical commissioning group
Clinical commissioning groups (CCGs) were NHS organisations set up by the Health and Social Care Act 2012 to organise the delivery of NHS services in each of their local areas in England. On 1 July 2022 they were abolished and replaced by Integra ...
s and
NHS trust
An NHS trust is an organisational unit within the National Health Services of England and Wales, generally serving either a geographical area or a specialised function (such as an ambulance service). In any particular location there may be several ...
s.
References
External links
*
{{Authority control
Department of Health and Social Care
Non-departmental public bodies of the United Kingdom government
National Health Service (England)
2011 establishments in England
Government agencies established in 2011