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The NHS White Paper, Equity and excellence: Liberating the NHS (July 2010) sets out the Government's long-term vision for the future of the NHS. Further details are available from the Department of Health website.


Population Coverage

Universal coverage of 51,000,000


Centrally funded from Department of Health England. Funding for hospital and primary care services is based on a set tariff per patient and per type of treatment.

Organisation at sub-national levels

9 Regions - 10 Strategic Health Authorities (SHAs). Strategic health authorities are responsible for:   developing plans for improving health services in their local area, making sure local health services are of a high quality and are performing well, increasing the capacity of local health services - so they can provide more services, and making sure national priorities - for example, programmes for improving cancer services - are integrated into local health service plans.  Strategic health authorities manage the NHS locally and are a key link between the Department of Health and the NHS

Approx 140 Primary Care Trusts (PCTs) are now at the centre of the NHS and control 80% of the NHS budget. As they are local organisations, they are best positioned to understand the needs of their community, so they can make sure that the organisations providing health and social care services are working effectively.

PCTs must make sure there are enough services for people within their area and that these services are accessible. They must also make sure that all other health services are provided, including hospitals, dentists, opticians, mental health services, NHS walk-in centres, NHS Direct, patient transport (including accident and emergency), population screening, and pharmacies. They are also responsible for getting health and social care systems working together for the benefit of patients.

Health care provision

England has opted for a commissioner/provider split.  PCTs assess population need and commission services accordingly from a variety of sources, including general practice, NHS provider arms, hospital trusts and private providers.  It is the only country in the UK that has made such a significant division between service commissioning and provision.

Organisation of public health

Public health follows the same trend as other service provision.  There are public health teams, led by a Director of Public Health (DPH), in each PCT.  These teams have varying degrees of responsibility for commissioning depending on the PCT.  In some cases the commissioning arm is under the DPH and/or reports directly to the DPH.  In other PCTs the public health team plays an advisory role to commissioners.  There are also public health providers, especially health improvement teams and public health nurses, who are managed by the provider arm of PCTs.

Local government authorities also have significant public health functions.  They manage environmental health and are responsible for such health related issues as waste management and disposal, hygiene and sanitation.

The Health Protection Agency covers all aspects of health protection in a region, and works in close collaboration with local government and PCTs.

The National Institute for Health and Clinical Excellence provides up to date guidance on health improvement based on the latest accumulated evidence.

The England Public Health strategy is Choosing Health.

Key differences

Commissioner-provider split within PCTs.

Key National Policies

See our Key National Policies section.


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