National Health Service

The aim of the National Health Service (NHS) is to improve the health and wellbeing of the population by promoting better health, helping to prevent illness, and providing the best treatment and continuing care when needed.

Context

Improving the health of all children and young people is a vital part the Every Child Matters: Change for Children programme, contributing directly to the "Be healthy" and "Stay safe" outcomes, and indirectly to others. Children and young people who are suffering from poor physical, emotional or mental health are less likely to "enjoy and achieve", and may have difficulty in "making a positive contribution" to their schools, local communities and wider society.

Within the NHS, the mechanism for improving the health of children and young people is the National Service Framework (NSF) for Children, Young People and Maternity Services. This was launched by the Department of Health in September 2004. The NSF is a ten-year programme designed to bring about sustained improvement in children's health and wellbeing.

Because full implementation is expected to take up to ten years, the NSF forms part of the NHS 'developmental standards' that NHS organisations must work towards ('core standards' are those which NHS bodies are expected to meet). They will be taken into account by the Healthcare Commission, which inspects health care provision in accordance with national standards and other service priorities, and reports directly to Parliament on the state of healthcare in England and Wales.

The NSF is an integral part of the Every Child Matters: Change for Children programme. Just as the programme can only be delivered by a number of organisations working in close partnership, so the NSF cannot be delivered by the NHS alone.

Like Change for Children, the NSF is intended to lead a cultural shift that will result in services that are designed and delivered around the needs of children and their families, rather than around the needs of organisations. Dr Sheila Shribman launched a progress report on the NSF on 14 November 2007, entitled Children's health, our future.

How is the NHS structured?

The Department of Health, led by the Secretary of State, is the government department responsible for setting the overall direction of the NHS. It sets national standards designed to improve service quality, secures resources and makes investment decisions to ensure that the NHS is able to deliver services.

The Department of Health works with key partners (such as the NHS Modernisation Agency and Strategic Health Authorities) to ensure the quality of services. Authorities and trusts are the different types of organisation that run the NHS at a local level.

Strategic health authorities

Created by the government in 2002 to manage the local NHS on behalf of the Secretary of State for Health, there were originally 28 Strategic Health Authorities (SHAs). On July 1 2006, this number was reduced to 10. Fewer, more strategic organisations will deliver stronger commissioning functions, leading to improved services for patients and better value for money for the taxpayer.

SHAs are responsible for:

• Developing plans for improving health services in their area 
• Making sure that services are of a high quality and performing well 
• Increasing the capacity of local services so that they can provide more services 
• Making sure that national priorities for example, programmes for improving children's services are integrated into local health service plans

SHAs manage the NHS locally and are a key link between the Department of Health and the NHS. Within each SHA, the NHS is split into various types of trusts that take responsibility for running the NHS at a more local level. SHAs and Government Offices work closely together: eight of the SHAs are coterrminous with a Government Office, and two (South East Coast and South Central SHAs) together fall within the GO South East boundaries.

Primary care trusts

Primary care is the care provided by people normally seen when someone first has a health problem. It might be a visit to a doctor or a dentist, an optician for an eye test, or just a trip to a pharmacist to buy cough mixture. NHS walk-in centres and the NHS Direct phone line service are also part of primary care. All of these services are managed for you by your local primary care trust (PCT).

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. PCTs are also responsible for getting health and social care systems working together for the benefit of patients. They will work with Local Authorities and other agencies that provide health and social care locally to make sure that local community's needs are being met.

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.

Care trusts

Care trusts work in both health and social care. They are set up when the NHS and local authorities agree to work closely together because it is felt this is the best way to improve local care services.

Care trusts may provide a range of services, including social care, mental health services, or primary care. At present, there is only a small number of care trusts in England.

Acute trusts

Hospitals are managed by acute trusts, which make sure that hospitals provide high-quality healthcare and spend their money efficiently. They also decide on strategy for how the hospital will develop, so that services improve.

Acute trusts employ a large part of the NHS workforce, including nurses, doctors, pharmacists, midwives and health visitors, as well as people doing jobs related to medicine physiotherapists, radiographers, podiatrists, speech and language therapists, counsellors, occupational therapists and psychologists. There are many other non-medical staff members employed by acute trusts, including receptionists, porters, cleaners, specialists in information technology, managers, engineers, caterers and domestic and security staff.

Some acute trusts are regional or national centres for more specialised care; others are attached to universities and help to train health professionals. Acute trusts may sometimes provide services in the community (e.g. through clinics or health centres).

Foundation trusts

These are a new type of NHS hospital run by local managers, staff and members of the public, which are tailored to the needs of the local population. Foundation trusts have been given more financial and operational freedom than other NHS trusts and have come to represent the government's commitment to de-centralising control of public services. Foundation trusts remain within the NHS and its performance inspection system. They were first introduced in April 2004, and there are now 67 foundation trusts in England.

Special health authorities

These are health authorities that provide a national  rather than local service to the whole of England, either to the public or to the NHS: for example NHS Direct, the National Blood Authority and the Heath Development Agency. They are independent, but can be subject to ministerial direction like other NHS bodies.

What do they do?

The Children Act 2004 requires all partners in a local area to cooperate with the local authority in making arrangements to deliver improved outcomes for children and young people. This includes SHAs and PCTs.

A key element of these arrangements is joint planning and commissioning by the partners involved; in particular working together on the new children and young people's plan, which every local authority had to have in place by April 2006.

Within the NHS, there is a basic five-stage delivery cycle to the provision of local services for children and young people. These stages can be seen as a continuous cycle of improvement which mirror those that children's trusts will follow in planning and commissioning services. The five stages are:

• Assessing the needs of children, young people and pregnant women (gathering, analysing and interpreting information to plan and improve services systematically) 
• Identifying priorities: setting targets and standards (this will include national targets, as well as local targets) 
• Planning services (PCTs work with local partners including local authorities to set three-year local delivery plans or LDPs) 
• Commissioning services to meet those needs (based on the LDP and children and young people's plan) 
• Managing performance, assessing and inspecting outcomes (this includes internal evaluation, performance management by SHAs, and inspection by the Healthcare Commission, other inspectorates and joint area reviews)

All PCTs were required to set LDPs in spring 2005 for the three financial years 2005/06-2007/08. The levels of performance in LDPs are agreed and signed off by SHAs; the Department of Health will in turn sign off SHA-level plans, ensuring that national performance expectations are fully agreed. More information is available in the document Supporting local delivery.

Local partners will need to ensure that the LDP and the children and young people's plan are consistent. Together, the two plans will form the basis for effective local commissioning. Key to the success of the NSF is how effectively local partners work together on commissioning services for children and young people, including the use of joint commissioning.

Where does the Children's National Service Framework fit in?

NSFs are long-term strategies for improving specific areas of healthcare by setting national standards for a defined service (e.g. cancer services or renal services) or a particular care group (e.g. children or older people).

A rolling programme of NSFs was launched in 1998 as part of the Government's drive to modernise the health service and drive up standards. Each NSF sets measurable goals within defined timescales.

The NSF for Children, Young People and Maternity Services was published in September 2004. It sets out a ten-year programme for sustained improvement in children's health and wellbeing by setting national standards for children's health and social services, and the interface with education, from before birth through to adulthood.

The first five core standards of the framework apply to universal services for all children; standards 6 to 10 apply to particular groups of children and young people: children who are ill, children in hospital, disabled children and children with complex needs, children who have mental health problems, and medicines for children. Standard 11 covers maternity services. The Children's NSF is directed at everyone involved in the delivery of services to children, young people or pregnant women.