How do NHS systems work in the 4 nations of the UK?
The four countries that make up the UK – England, Wales, Scotland and Northern Ireland – have different health systems, as healthcare in the UK is devolved.
England
Health services in England are centrally funded from the Department of Health and Social Care, based on a set tariff per patient and type of treatment.
The NHS provides healthcare services through NHS trusts, foundation trusts (including mental health and ambulance trusts), general practices, as well as some charities and social enterprises.
42 Integrated care systems (ICSs) were established in July 2022 to join up health and care services in an area. The integrated care boards (ICBs) within these ICSs plan and commission (buy) services their patients need.
A national body – NHS England – oversees the NHS budget of approximately £179 billion a year and its area teams are responsible for commissioning the following:
- GP
- dental
- pharmacy
- some optical services.
NHS England’s area teams also have overall responsibility for screening and immunisation programmes.
Public health in England
Public health services in England are primarily delivered through:
- The Office for Health Improvement and Disparities (OHID)
- Local authorities that have public health responsibilities.
Local authorities also have statutory responsibilities to ensure systems are in place to protect the health of the population and to provide information and advice in the event of a health protection incident or outbreak.
Scotland
Scotland also has its own devolved government with various responsibilities, including health. However, some reserved powers remain with the UK Government, such as immigration and foreign policy.
The Scottish Government receives a grant from the UK Government to fund health services, including NHS Scotland. It makes decisions on how to use this funding to deliver health and care services in Scotland.
NHS Scotland consists of 14 regional health boards and eight national boards. Together, these 22 organisations provide and support the delivery of healthcare services for over five million people living in mainland and island communities across Scotland.
These boards also work in partnership with the Scottish Government, local authorities, and other agencies to reduce health inequalities and provide education and training for the health and care workforce.
Wales
As a devolved administration, Wales receives a grant from the UK central government which is then distributed between the different departments, including NHS Wales. The main difference for patients in Wales is that prescriptions for medicines are free for everyone.
Health services in Wales are delivered through seven health boards and three NHS trusts, each one responsible for delivering all healthcare services within a particular geographical area. The three NHS trusts in Wales with an all-Wales focus are:
- The Welsh Ambulance Services Trust for emergency services
- Velindre University NHS Trust which offers specialist services in cancer care
- Public Health Wales.
The seven health boards work together, with community health councils which represent patients and user groups.
Northern Ireland
In Northern Ireland in that both health and social care are provided through an integrated service and prescriptions for medical care are free for everyone.
Northern Ireland receives a block grant from the UK Treasury which funds the Department of Health, Social Services and Public Safety for Northern Ireland (DHSSPS). The DHSSPS has overall responsibility for providing health and social care services in Northern Ireland, including public health and public safety.
Health and Social Care Board
Working under the DHSSPS, a Health and Social Care Board is responsible for:
- Commissioning services
- Resource management
- Performance management
- Service improvement
The Health and Social Care Board works to identify and meet the needs of the Northern Ireland population through its five local commissioning groups. The local commissioning groups cover the same geographical areas as five health and social care trusts that deliver health and social care services.
A separate trust – Northern Ireland Ambulance Trust – provides ambulance services across Northern Ireland.
Public health in Northern Ireland
The Public Health Agency (PHA) is responsible for:
- Health protection
- Screening
- Health and social care research and development
- Safety and quality
- Improving health and social wellbeing
It also provides public health, nursing and allied health professional advice to support the Health and Social Care Board and its local commissioning groups.
Summary
We have described how NHS systems work in the 4 nations of the UK. We hope it has been helpful.
