The NHS in england

The Department of Health sets the national standards and shapes the direction of the NHS in England. It sets out the priorities for the NHS each year in a document entitled The NHS Operating Framework. The work of the Department of Health is supported by various bodies known as Arm’s Length Bodies (or ‘quasi non-governmental organisations’ colloquially known as ‘quangos’). These include the Care Quality Commission (CQC), Monitor and the National Institute for Health and Clinical Excellence (NICE).

GPs are deemed to be at the pivot of the NHS in England. The commissioning groups led by the GPs receive around 80% of the NHS budget, which they then spend on purchasing services from NHS trusts and other providers. In theory, since GPs should commission high-quality providers rather than those who provide poor-quality service, standards should rise over time. Indeed, the commissioning groups can even withhold a percentage of payments if the agreed quality standards are not met. These include standards for which you are responsible such as the number of patient falls, incidents or complaints, or even the levels of staffing.

In addition, the Department of Health employs a chief nursing officer (CNO) for England, who is the most senior nurse advisor to the government. Accessing the Department of Health Web site (www.dh.gov.uk) regularly is a wise move for all nurse managers. It gives updated information about relevant issues in the NHS which have an impact on all nurses and midwives. It also enables you to access link Web sites to obtain further information about issues that will affect your work.

The NHS in wales, scotland and northern ireland

Wales, Scotland and Northern Ireland have not adopted the system of commissioning between purchasers (GPs) and providers (hospitals), i.e. the ‘internal market’. Instead, each country has a system of regional health bodies which plan and commission all hospital, GP and other health care services for their local populations. In Wales and Scotland they are called health or NHS boards; in Northern Ireland they are called health and social care trusts. Each country has its own Department of Health responsible for policy direction, and a body similar to the CQC for setting national clinical standards, ensuring they are put into practice and monitoring performance. Although the health systems are managed separately, there is some overlap; for example, the NICE guidelines currently apply to both Wales and England.

Each country in the UK also has its own CNO as their most senior nurse advisor. For further information, see:

Private health care

At the time of writing this book there are various private companies in the UK providing acute care, the biggest being BMI Healthcare which has over 70 hospitals, closely followed by Spire Healthcare with 37 hospitals, Nuffield Health with 32 hospitals, and Ramsay Health Care UK with 22 hospitals across the UK. There are many other smaller companies. Private hospitals base their standards along the relevant NHS regulations and guidelines. In England, they have to register with the CQC and thus meet the same care quality standards as the NHS.

Be aware of the wider organisation

This is basic information about how health care is run in the UK. If you did not know much of it before, do rest assured that you are not alone. Nurses are often so focused on managing their day-to-day pressures that being aware of the wider organisation has never been a priority. However, once you become a nurse manager, you will find it helpful to become more aware of the ‘bigger picture’. Don’t fall into the trap of thinking that ‘what happens out there does not concern me’ or ‘I haven’t got time for that’. If you do not know how the system works, you cannot influence it.

Make it a personal goal from now on to keep yourself abreast of the ongoing changes both nationally and within your own organisation. All this information is now freely available on the relevant NHS Web sites (national or local). Because it is for the general public, it is easy and quick to read as most of the jargon tends to be removed.

Getting to know your board of directors

The board of directors is a very powerful body, so it makes sense to build alliances and networks with some of the key players on the board so you can benefit. The director of nursing is the nurse with the greatest authority within the organisation, yet it has been found that nearly 40% of nurses do not even know who their nursing director is (Royal College of Nursing 2010). The board usually holds a meeting in public every month. Anyone can attend to listen and ask questions. Going along to these board meetings is an easy way of getting to know and understand what is going on. Take staff along for the experience and to help develop their political awareness.

Many chief executives also hold regular ‘open forums’. They book a couple of hours in their diaries where they will be available at a certain venue for anyone to come along and ask questions. These are not only information-giving meetings; they are there for the staff to raise and discuss any issues or concerns.

Another easy way of finding out what your trust board’s priorities and plans are is via the intranet or in the annual business plan. This plan is open to the public and therefore written in an easily readable style. You need to know what your board’s priorities are. If the priorities of your ward or department are different from those of the trust board, you will not get very far with them.

For those working in private health care, the system is less complex, but it is necessary that you make yourself aware of what your company’s priorities are, if you have not already done so.