Healthcare in England is mainly provided by the National Health Service (NHS), a public body that provides healthcare to all permanent residents in England, that is free at the point of use.
The body is one of four forming the UK National Health Service, as health is a devolved matter; there are differences with the provisions for healthcare elsewhere in the United Kingdom, and in England it is overseen by NHS England. Though the public system dominates healthcare provision in England, private health care and a wide variety of alternative and complementary treatments are available for those willing and able to pay.
The Secretary of State for Health and Social Care is a senior minister of the Crown within the Government of the United Kingdom, and leads the Department of Health and Social Care with responsibility for England's NHS. The Secretary serves as the principal adviser to the prime minister of the United Kingdom on all health matters.
National Health Service The NHS is free at the point of use for the patient though there are charges associated with eye tests, dental care, prescriptions, and many aspects of personal care.
The NHS provides the major part of healthcare in England, including primary care, in-patient care, long-term healthcare, ophthalmology and dentistry. The National Health Service Act 1946 came into effect on 5 July 1948. Private health care has continued parallel to the NHS, paid for largely by private insurance, but it is used by less than 8% of the population, and generally as a top-up to NHS services. Recently there have been some examples where unused private sector capacity has been used to increase NHS capacity and in some cases the NHS has commissioned the private sector to establish and run new facilities on a sub contracted basis. The involvement of the private sector remains relatively small and according to one survey by the BMA, a large proportion of the public oppose such involvement.
Common features The NHS uses General Practitioners (GPs) to provide primary healthcare and to make referrals to further services as necessary. Hospitals then provide more specialist services, including care for patients with psychiatric illnesses, as well as direct access to Accident and Emergency (A&E) departments. Pharmacists are able to prescribe medication. Community pharmacies are privately owned but have contracts with the national health service to supply prescription drugs.
The public healthcare system also provides free (at the point of service) ambulance services for emergencies, when patients need the specialist transport only available from ambulance crews or when patients are not fit to travel home by public transport. These services are generally supplemented when necessary by the voluntary ambulance services (British Red Cross, St Andrews Ambulance Association and St John Ambulance). In specific emergencies, emergency air transport is also provided by naval, military and air force aircraft of whatever type might be appropriate or available on each occasion.
Dentists can only charge NHS patients at the set rates. Dental care is free for patients under 18 years old (19 if still in full-time education), with certain medical conditions, on low incomes or in receipt of welfare benefits. About half of the income of dentists in England comes from work sub-contracted from the NHS, however not all dentists choose to do NHS work.
In England, a fixed NHS prescription charge is payable for up to a three-month supply of each item (£9.35 ), regardless of actual cost. Reviewed every 3 years. There are many exemptions from the charge, including patients under 16 years old (18 if still in full-time education), over 60, with certain medical conditions, on low incomes or in receipt of welfare benefits. Permanent residents in England who are liable to pay prescription charges can purchase a Prescription Prepayment Certificate (PPC) covering all prescriptions in a specified period.
When purchasing drugs, the NHS has significant market power that, based on its own assessment of the fair value of the drugs, influences the global price, typically keeping prices lower. Several other countries either copy the UK's model or directly rely on the country's assessments for their own decisions on state-financed drug reimbursements.
Commissioning Integrated care systems (ICSs) were put on a statutory footing in England on 1 July 2022 by the Health and Care Act 2022, replacing clinical commissioning groups. A total of 42 ICSs across England now plan and coordinate services, with aims including better integration and reducing health inequalities.
Funding and management
The NHS is divided conceptually into two parts, covering primary and secondary care, with trusts given the task of healthcare delivery. There are two main kinds of trusts in the NHS reflecting purchaser/provider roles: commissioning trusts are responsible for examining local needs and negotiating with providers to provide healthcare services to the local population, and provider trusts which are NHS bodies delivering healthcare service. Commissioning trusts negotiate service delivery with providers that may be NHS bodies or private entities. They will be involved in agreeing major capital and other healthcare spending projects in their region.
By far the most known and most important purchases are services including general practice physician services (most of whom are private businesses working under exclusive contract to the NHS), community nursing, local clinics and mental health service. For most people, the majority of healthcare is delivered in a primary care setting. Provider trusts are care deliverers, the main examples being the hospital trusts and the ambulance trusts which spend the money allocated to them by the commissioning trusts. Because hospitals tend to provide more complex and specialised care, they receive the lion's share of NHS funding.Secondary care consumes more costs than any other part of the spending of PCTS. See Figure A.15 in Financial Data Tables taken from DH Annual Report
The hospital trusts own assets (such as hospitals and the equipment in them) purchased for the nation and held in trust for them. Some hospitals and trusts are affiliated with universities, like the Queen Alexandra Hospital in Portsmouth, affiliated with the University of Portsmouth. University hospitals are speciality trusts with involvement in research and education. Commissioning has also been extended to the very lowest level enabling GPs who identify a need in their community to commission services to meet that need. Primary care is delivered by a wide range of independent contractors such as GPs, dentists, pharmacists and optometrists and is the first point of contact for most people. Secondary care (sometimes termed acute health care) can be either elective care or emergency care and providers may be in the public or private sector, but the majority of secondary care happens in NHS owned facilities.
The Care Quality Commission is an executive non-departmental public body of the Department of Health and Social Care. It was established in 2009 to regulate and inspect health and social care services in England. The CQC's stated role is to make sure that hospitals, care homes, dental and general practices and other care services in England provide people with safe, effective and high-quality care, and to encourage those providers to improve. It carries out this role through checks during the registration process which all new care services must complete, as well as through inspections and monitoring of a range of data sources that can indicate problems with services.
The Department of Health and Social Care (DHSC) is the government department responsible for government policy on health and adult social care matters in England. The department develops policies and guidelines to improve the quality of care and to meet patient expectations. It carries out some of its work through arm's-length bodies (ALBs), including executive non-departmental public bodies such as NHS England, and executive agencies such as the Office for Health Improvement and Disparities (OHID), the UK Health Security Agency and the Medicines and Healthcare products Regulatory Agency (MHRA). Health Education England is responsible for ensuring enough high-quality training is available to develop the healthcare workforce.
The NHS also conducts research through the National Institute for Health and Care Research (NIHR). The National Institute for Health and Care Excellence (NICE) is an executive body of the Department of Health and Social Care in England that publishes guidelines in the use of health technologies, the use of new and existing medicines, treatments and procedures, clinical practice (guidance on the appropriate treatment and care of people with specific diseases and conditions), guidance for public sector workers on health promotion, and ill-health avoidance guidance for social care services. These appraisals are based primarily on evidence-based evaluations of efficacy, safety and cost-effectiveness in various circumstance.
The NHS is the world's largest health service and the world's fourth-largest employer.
NHS Constitution The NHS Constitution for England establishes the principles and values of the NHS in England. It sets out rights to which patients, public and staff are entitled, and pledges which the NHS is committed to achieve, together with responsibilities, which the public, patients and staff owe to one another to ensure that the NHS operates fairly and effectively. The Secretary of State for Health and Social Care, all NHS bodies, private and voluntary sector providers supplying NHS services, and local authorities in the exercise of their public health functions are required by law to take account of the constitution in their decisions and actions.
The NHS is founded on a common set of principles and values that bind together the communities and people it serves – patients and public – and the staff who work for it. Seven key principles guide the NHS.
The NHS provides a comprehensive service, available to all Access to NHS services is based on clinical need, not an individual's ability to pay The NHS aspires to the highest standards of excellence and professionalism The patient will be at the heart of everything the NHS does The NHS works across organisational boundaries The NHS is committed to providing best value for taxpayers’ money The NHS is accountable to the public, communities and patients that it serves
Patient experience A patient needing specialist care at a hospital or clinic will be informed by the GP of the hospitals where they can get their treatment. This choice usually includes public and private hospitals. The NHS will pay for treatment in a private setting if the hospital meets the cost and service criteria that NHS hospitals adhere to; otherwise, opting for a private hospital makes the patient liable for private hospital fees. Because the private sector often has higher costs, most people choose to be treated for free in an NHS hospital. If the GP judges the case to be extremely urgent, the doctor may bypass the normal booking system and arrange an emergency admission.
Patients can be seen by the hospital as out-patients or in-patients, with the latter involving an overnight stay. The speed of in-patient admission is based on medical need and time spent waiting, with more urgent handled more quickly.
In 2008, trusts were working towards an 18-week guarantee: the hospital aimed to complete all tests and start treatment within 18 weeks of the date of the referral from the GP.