Structure of the NHS in 2025 - How The NHS in England Works - Health And Care Systems & NHS England in 2025
Updated: Dec 16
When discussing problems facing the NHS during an interview, such as increased waiting times, the NHS winter crisis and the NHS obesity crisis in the UK, it is essential to know about the structure of the UK healthcare system to identify which sectors may be impacted the most.
The structure of the NHS is complex and ever-changing, impacted by government officials, business managers as well as healthcare professionals.
This article breaks down the people and organisations that influence how the NHS is run, along with an insight into how this is monitored and regulated externally.
Summary of NHS Structure in 2025
NHS Oversight: The Secretary of State for Health and Social Care oversees the NHS, setting mandates and allocating finances.
DHSC Role: The Department of Health and Social Care develops health policies and allocates funds to NHS organisations, including NHS England and Health Education England.
NHS England: Manages the allocation of funds to NHS Trusts and Integrated Care Boards, ensuring efficient healthcare delivery across the country.
Integrated Care Boards: Local bodies responsible for planning and commissioning healthcare services tailored to regional needs, replacing Clinical Commissioning Groups.
NICE: Provides evidence-based guidance and evaluates treatments to ensure high-quality, cost-effective healthcare services across the NHS.
Who is in charge of the NHS in 2024?
Commonly perceived as a single entity, the National Health Service (NHS) is in reality a combination of organisations working together, consisting of doctors, managers and other health care professionals.
The Secretary of State for Health and Social Care:
Decides how health services are organised by allocating finances
Writes the NHS mandate, a set of key aims and expectations for the NHS for the following year. This is fulfilled by NHS England.
Is able to intervene where they feel certain bodies of NHS England may be lacking, or failing to meet targets.
Develops public health initiatives by ensuring health-related legislation is recognised in parliament.
Past Holders of the Role
Victoria Atkins: Serving since November 2023
Steve Barclay: 2022-2023
Thérèse Coffey: 2022
Sajid Javid: 2021-2022
Matt Hancock: 2018-2021
Jeremy Hunt: 2012-2018
The Department for Health and Social Care (DHSC):
The Department of Health and Social Care (DHSC) is the central government body responsible for overseeing health and social care policy in England.
It ensures the effective functioning of the National Health Service (NHS) and other health-related bodies by setting overall health policy and allocating necessary funds. The key roles of the DHSC include:
Formulating Health Policy: Developing and implementing health and social care policies to improve the healthcare system.
Funding Allocation: Distributing financial resources to vital health organisations and bodies, such as:
NHS England: Manages the planning and delivery of NHS services.
Health Education England (HEE): Focuses on the training and education of healthcare professionals.
UK Health Security Agency (UKHSA): Handles public health protection and responses to health threats.
Local Authorities: Manage public health initiatives and services at the community level.
The DHSC plays a critical role in ensuring the NHS operates efficiently and effectively, maintaining the overall health standards of the population.
NHS England:
NHS England, an arm of the Department of Health and Social Care (DHSC), is responsible for allocating funding to NHS Trusts and NHS Foundation Trusts through direct commissioning.
It operates under the NHS mandate set out by the Secretary of State for Health and Social Care, which targets funding to relieve specific pressures such as waiting lists.
Following the Health and Care Act 2022, NHS England also allocates funds to Integrated Care Boards (ICBs). These boards, like NHS England, direct funding to NHS Trusts to ensure patient care across the country is adequately funded and managed.
This structure aims to enhance the efficiency and effectiveness of healthcare delivery, ensuring that resources are used where they are most needed.
Health Education England (HEE)
Health Education England (HEE) is an essential part of the UK's healthcare system, dedicated to the training and education of future healthcare professionals.
It ensures that the healthcare workforce is well-prepared and equipped with the necessary skills to deliver high-quality patient care. HEE collaborates with universities, NHS organisations, and other educational bodies to create comprehensive training programmes and continuous professional development opportunities.
This ensures that healthcare professionals, including doctors, nurses, and allied health professionals, receive the best possible education and training to meet the evolving needs of the healthcare sector.
Integrated Care Boards (ICBs)
Integrated Care Boards (ICBs) play a crucial role in the NHS by directing funding to NHS Trusts to ensure high-quality patient care across the country.
They were established as part of the Health and Care Act 2022, replacing Clinical Commissioning Groups (CCGs) to enhance local healthcare delivery and integration.
Unlike NHS England, which operates on a national level, ICBs focus on the specific healthcare needs of their local regions. They collaborate closely with the community, charities, and local government to tailor healthcare services to meet local demands effectively.
This localised approach allows ICBs to address unique health challenges within their areas, ensuring that resources are allocated efficiently and that healthcare delivery is responsive to the needs of the population.
By fostering partnerships and community involvement, ICBs enhance the integration and coordination of health services, ultimately improving patient outcomes and overall health system performance.
The remainder of the budget that does not go towards the NHS Trusts or Integrated Care Boards distributes money to bodies such as:
Central admin and programme
Elective services such as diagnostic scans
Prison and Youth Offender healthcare services
Military and veteran healthcare
What is the Difference Between ICBs and NHS England?
NHS England and Integrated Care Boards (ICBs) have distinct roles within the NHS framework. NHS England operates at a national level through its seven regional teams, focusing on improving the overall standards of NHS Trusts and implementing national health policies via the NHS workforce.
In contrast, ICBs operate at a local level, addressing specific healthcare needs within their regions. Formed under the Health and Care Act 2022, ICBs work closely with integrated care partnerships that include community members, charities, and local government.
NHS Foundation Trusts
NHS Foundation Trusts are semi-independent organisations within the NHS, offering the flexibility to manage their budgets and customise services to address local needs effectively.
Unlike standard NHS Trusts, Foundation Trusts have greater autonomy, allowing them to innovate and respond swiftly to the unique healthcare requirements of their communities.
They operate hospitals and community health services, ensuring that high standards of care are maintained. Foundation Trusts are accountable to local communities, with governance structures that include members and governors drawn from patients, staff, and the public.
They are also regulated by NHS Improvement, which oversees their performance and financial stability to ensure they deliver safe, effective, and high-quality healthcare services.
How NHS Foundation Trusts Differ from Integrated Care Boards (ICBs)
While NHS Foundation Trusts focus on the operational management of hospitals and community health services, Integrated Care Boards (ICBs) have a broader, strategic role in the NHS. ICBs are responsible for planning and commissioning healthcare services to meet the needs of their local populations.
They allocate funding to various healthcare providers, including NHS Trusts and Foundation Trusts, to ensure resources are used effectively and healthcare delivery is coordinated across their regions.
In summary, NHS Foundation Trusts deliver direct patient care and manage health services, enjoying a degree of financial and operational independence.
In contrast, ICBs oversee the strategic distribution of resources and coordination of services across multiple providers to address local health needs comprehensively.
The Role of Public Health England (PHE) in the NHS
Public Health England (PHE) plays a crucial role in protecting and improving the nation's health. Working closely with the NHS, PHE is responsible for implementing public health initiatives, managing disease outbreaks, and promoting healthy lifestyles.
These efforts are vital for illness prevention and enhancing overall community health. PHE collaborates with healthcare providers to ensure a coordinated response to public health challenges, such as pandemics, seasonal flu, and lifestyle-related diseases.
PHE's initiatives include vaccination programmes, smoking cessation campaigns, and nutritional guidance, all aimed at reducing health inequalities and improving the population's well-being. By analysing health data and conducting research, PHE provides evidence-based recommendations that shape health policies and practices across the UK.
NHS Structure - how has it changed over time?
The structure of the NHS has changed significantly since its creation in 1948. But fundamentally, it remains a system that provides health care free at the point of delivery.
Here is a timeline of those changes - showing how the funding that used to be allocated by GPs is now distributed by Integrated Care Boards, reflecting the specific needs of the local population to enhance community-based care.
1991-1997
Primary-care-led commissioning = GPs were given budgets to buy a range of services on behalf of their patients.
1997-2010
Policies were introduced allowing patients greater autonomy, such as the ability to choose where they received hospital treatment.
2012
The Health and Social Care Act 2012 introduces Clinical Commissioning Groups (CCGs). Following their introduction, there is greater scope for change in the NHS on a national level. In addition to this increased autonomy, CCGs are also a response to the 2013 Francis report into the Mid Staffordshire Failings.
👉🏻 Read more: The Francis Reports and Mid Staffordshire Failings
2012 - 2014
The introduction of the Sustainability and Transformation Plans (STPs) sees the move towards a triple integration system.
This integrates primary care services with mental health, community and social care. There is a large and significant shift towards considering the patient holistically, through the integration of services.
2014
The Five Year Forward View is published, emphasising the need for cohesion between primary care services and social care. The STPs are renamed Sustainability and Transformation partnerships, and 42 are established nationwide.
2019
The NHS Long Term Workforce Plan is published. Included is a detailed list of ways that the NHS will integrate its services by maximising and directing funding to areas that need it, such as maternity and mental health services as well as technology and innovation. The LTP formalises the transition from 42 STPs to 42 Integrated Care Systems.
2022
The introduction of the Health and Care Act 2022 abolished CCGs, replacing them with ICBs.
This allowed cohesion between local and national governments in an effort to make healthcare provision specific to the population it serves. ICBs focus on fulfilling values of the NHS Constitution: reducing health inequalities, and promoting doctor-patient collaboration and innovation.
Read on to find out more about what the current system is and what the ICSs hope to achieve…
What are Integrated Care Systems (ICS) in Health and Social Care?
On 1 July 2022, the Integrated Care System model was introduced, replacing CCGs, or Clinical Commissioning Groups. But what exactly is an ICS and what does it mean for us in the future? Read on to find out
The Integrated Care Systems (ICSs) split into Integrated Care Boards (ICBs) and Integrated Care Partnerships (ICPs)
ICBs = responsible for the provision of NHS services in the specific area.
ICPs = collaborate with the local population, authorities and other organisations to ensure that ICBs fulfil their targets.
There are 42 ICSs in the UK, each serving their region. You can look up the ICS covering your area here. The number of ICSs in an area will vary based on the size of the population it serves. For example, there are 5 ICSs in London compared to 1 ICS for Lincolnshire, a much larger but less densely populated area.
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How is the NHS funded in 2024?
The NHS is ultimately funded by the taxpayer. This is through General taxation and National Insurance Contributions. A small percentage comes from service charges such as hospital car parking payments and medical prescriptions.
General taxation: This refers to Income tax, a deduction that goes towards services in society. Local governments decide how much of this will be directed towards healthcare spending to improve the health and well-being of a population.
National Insurance Contributions (NICs): This is money that contributes to State Pensions and NHS Services.
The flow of funding is a relatively simple pathway to follow, starting with the Secretary of State for Health and Social Care and ending with the NHS providers that fund the treatment we see in our local A&E in secondary care.
If we reverse the flow of funding we see who is accountable for funding allocation. For example, NHS providers will be accounted for by the Integrated Care Boards, who in turn, report to NHS England.
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How are NHS services regulated?
A variety of forms of assessment are in place. We will now delve into each of these.
Care Quality Commission (CQC)
Established in April 2009, the Care Quality Commission (CQC) is the independent regulator of health and adult social care services in England. The CQC's primary role is to ensure that health and social care services provide people with safe, effective, compassionate, and high-quality care.
What Does the CQC Do?
The CQC carries out inspections and monitors a wide range of services, including hospitals, care homes, GP practices, dental surgeries, and other care services. During these inspections, they assess the quality of care provided and ensure that services meet fundamental standards of quality and safety.
After an inspection, the CQC rates each service provider using four ratings: Outstanding, Good, Requires Improvement, and Inadequate. These ratings help the public make informed choices about their care and encourage service providers to improve their services.
Local Authorities In Healthcare
Local authorities play a vital role in maintaining and improving public health services. They are responsible for:
Health Assessments: Local authorities assess the health needs of their communities to ensure that local health services are meeting those needs effectively.
Public Health Promotion: They work on promoting healthy lifestyles and preventing illness through various public health campaigns and initiatives.
Service Coordination: Local authorities coordinate with the NHS and other health service providers to ensure that services are delivered efficiently and effectively.
Funding Allocation: They allocate funding to various health and social care services, ensuring resources are used where they are most needed.
By carrying out these functions, local authorities help ensure that health services are accessible, effective, and tailored to the needs of their communities.
NICE (National Institute for Health and Care Excellence):
The National Institute for Health and Care Excellence (NICE) is a key player in the UK healthcare system, providing evidence-based guidance and advice to improve health and social care. Here's a closer look at what NICE does:
Evidence-Based Guidance: NICE develops comprehensive, evidence-based guidelines for health services, medications, and social care. This guidance helps ensure that patients receive the best possible care based on the latest research.
Recommending Action Plans: NICE recommends specific plans of action for treating various medical conditions. These plans are designed to standardise care across the NHS, ensuring that patients receive consistent and high-quality treatment.
Evaluating QALYs: One of the crucial roles of NICE is to evaluate the Quality Adjusted Life Years (QALYs) that a patient can gain from a specific treatment. This assessment helps determine the value and effectiveness of different treatments, guiding decisions on which treatments should be funded by the NHS.
Reviewing New Drugs: NICE reviews all new drugs launched in the UK to assess their efficacy, safety, and cost-effectiveness. This rigorous review process ensures that only the most beneficial and cost-effective medications are made available to patients.
By performing these functions, NICE plays an essential role in ensuring that healthcare resources are used effectively and that patients receive treatments that are both beneficial and cost-effective. Their work supports the NHS in delivering high-quality care to all patients across the UK.
👉🏻 Read more: QALYs: The Ultimate Guide
How will the structure of the NHS change in the future?
Major reforms to the NHS vary based on the political party leading the country at the time. However, there are some common issues to be tackled in the next decade. These include a focus on prevention and tackling the social determinants of health.
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👉🏻 Read more: Obesity Crisis in the UK
The Hewitt Review 2022 set out changes we might expect to see within the NHS in the next decade.
These include:
Increased collaboration between ICSs and National bodies
Promoting local leadership and initiative
A shift in resources from treatment towards health promotion strategies. By 2027, prevention funding is aimed to increase by ‘at least 1%’.
The Major Conditions Strategy 2023 aims to:
Tackle ‘major conditions’ that are most prevalent in society, therefore decreasing the burden of disease. Examples include Cancers, Dementia, and Cardiovascular diseases.
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The Role of NHS Digital in Modernising Healthcare
NHS Digital is a crucial part of the NHS structure, focusing on enhancing healthcare services through advanced information technology. By developing and maintaining national IT systems, NHS Digital ensures efficient patient care delivery, effective management of patient records, and secure data handling. The organisation also provides vital data analytics to support decision-making and policy development across the NHS.
NHS Digital Transformation: NHS Digital leads the digital transformation of healthcare services, utilising innovative technologies to streamline operations and improve patient outcomes. By integrating electronic health records (EHRs), telehealth solutions, and digital patient portals, NHS Digital enhances healthcare accessibility and efficiency.
NHS Structure Frequently Asked Questions
Who is in Charge of the NHS?
The NHS is overseen by the Secretary of State for Health and Social Care, who is responsible for the overall organisation of health services and the allocation of funding.
What is the Role of the Secretary of State for Health and Social Care in the NHS?
The Secretary of State sets the NHS mandate, outlining key aims for NHS England to achieve. They also allocate finances to the Department of Health and Social Care and can intervene when targets are not met.
How Does NHS England Allocate Funding?
NHS England allocates funding to NHS Trusts, Foundation Trusts, and Integrated Care Boards (ICBs) based on the NHS mandate and national priorities. This ensures that resources are distributed to meet the healthcare needs of the population.
What are Integrated Care Boards (ICBs) in the NHS?
Integrated Care Boards (ICBs) are local bodies that plan and commission healthcare services to meet the specific needs of their local populations. They ensure that funding is used efficiently and that healthcare services are tailored to community needs.
How Has the Structure of the NHS Changed Over Time?
The NHS has evolved from GP-led commissioning to integrated care systems. This evolution has focused more on community-based care and collaboration, ensuring that healthcare services are more coordinated and effective.
What Was the Impact of the Health and Care Act 2022 on the NHS?
The Health and Care Act 2022 replaced Clinical Commissioning Groups (CCGs) with Integrated Care Boards (ICBs) to enhance collaboration between local and national health services. This change aimed to improve the integration and efficiency of healthcare delivery.
How is the NHS Funded Through General Taxation and National Insurance Contributions?
The NHS is primarily funded through general taxation and National Insurance Contributions. Additional revenue comes from service charges, such as hospital car parking fees, ensuring a sustainable funding model for healthcare services.
What are Integrated Care Systems (ICSs) and How Do They Work?
Integrated Care Systems (ICSs) consist of Integrated Care Boards (ICBs) and Integrated Care Partnerships (ICPs). They collaborate to provide cohesive healthcare services tailored to specific regions, promoting integrated and efficient healthcare delivery.
How Does the Care Quality Commission (CQC) Ensure the Quality of NHS Services?
The Care Quality Commission (CQC) inspects, monitors, and rates healthcare providers to ensure they meet quality and safety standards. This helps maintain high standards of care across the NHS.
What Role Do Local Authorities Play in Assessing NHS Services?
Local authorities assess and evaluate health services through health overview and scrutiny committees. They ensure that healthcare services meet local needs and maintain high standards.
What Changes Were Introduced by the NHS Long Term Plan?
The NHS Long Term Plan emphasised integrating services, improving mental health and maternity care, and leveraging technology and innovation. These changes aim to enhance the efficiency and quality of healthcare services.
What Future Reforms Are Expected for the NHS?
Future reforms for the NHS focus on prevention, health promotion, and increased collaboration between local and national health bodies. These reforms aim to improve healthcare outcomes and ensure a sustainable healthcare system.
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