HealthManagement, Volume 5 - Issue 3,2006

The British Health System

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Ruth Ivory

Title: Managing Editor, Imaging Management


More than 90% of healthcare in Great Britain is provided by the National Health System (NHS). The remaining healthcare provision is from independent practitioners and hospitals.


The NHS is run by Central Government, led by the Secretary of State for Health and a team of ministers at the Department of Health. The Department is responsible for planning a health strategy in England. Within that department, the NHS Management Executive leads management of the service, which is responsible for developing policies that ensure the quality of health services. The Executive has eight regional offices, which liase with the health authorities in their region, accountable to their local populations and to the Department of Health. The Department monitors the performance of strategic health authorities against targets, set out in the NHS Plan (2000).


The Healthcare Commission monitors the quality of the NHS and independent healthcare and the value of additional investment in the NHS, enabling them to judge how performance is improving. Arm's length bodies (ALBs) are responsible for inspection and regulation, setting and improving standards and promoting public welfare across the entire health and social care system. All aspects of health care provided by the NHS have been historically paid for and managed by the NHS. It pays health expenses directly without the need for a reimbursement system and is funded by central taxation. It is free at the point of use, except for a few areas such as prescriptions and dentistry, which provide a small percentage of income to the NHS from fees.


The NHS employs the doctors and nurses that provide health care and owns and runs the hospitals and clinics that it uses.


Private enterprise is now involved in building some hospitals under the Private Finance Initiative, and non-medical services (such as catering) are provided under contract by private companies. General practitioners, who provide most primary care services and act as gatekeepers to many specialist and hospital services, are self-employed and under contract to the NHS.


NHS hospitals provide acute and specialist secondary care services, treating cases referred by a GP or which are brought in as an emergency. Secondary care is run by a large number of management groups called trusts. These NHS trusts primarily run hospitals and the management boards comprise executive and non-executive directors under a non-executive chairperson. Some specialised care is run by regional and national trusts and those training doctors and nurses are University Hospital Trusts. Recent developments include Foundation Trusts which have greater management freedom from the Department of Health but are subject to NHS standards. They enable local managers, staff and members of the public to tailor and develop their services to the needs of the local population.


NB. Community Health Councils still exist in Wales but have been abolished in England and replaced by Hospital Patient Forums for each Hospital Trust.


IT is being renovated through the NHS National Programme for IT (NpfIT) in England and Informing Healthcare in Wales. This ambitious programme aims to deliver integrated high quality electronic communications between primary and secodary care and subsequently EPR and improve healthcare professionals’ access to medical data while providing tight controls on security and privacy.

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Author: Ruth Ivory Title: Managing Editor, Imaging Management Email: [email protected] More than 90% of healthcare in Great Britain

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