NHS Structure

The NHS is a publicly funded healthcare system, mainly financed through taxation, that provides healthcare free at the point of use for UK residents.

1. Who Runs the NHS?

NHS Structure Diagram

UK Government
      ↓
Secretary of State for Health & Social Care
      ↓
Department of Health & Social Care (DHSC)
      ↓
NHS England
      ↓
Integrated Care Boards (ICBs)
      ↓
NHS Trusts / GP Practices / Community Services
      ↓
Patients

2. Secretary of State for Health & Social Care

Currently: Wes Streeting

Key Responsibilities

Sets NHS priorities
Controls healthcare budget allocation
Oversees national health policy
Writes the NHS Mandate
Accountable to Parliament

Interview Point

You should mention:

“The Secretary of State provides political leadership and determines national healthcare priorities, while operational delivery is delegated to NHS organisations.”

3. Department of Health & Social Care (DHSC)

Main Role

The DHSC creates national health policies and distributes funding.

Organisations Overseen

NHS England
UKHSA
Local authorities
Workforce and training bodies

4. NHS England

Main Functions

NHS England:

Allocates NHS funding
Monitors NHS performance
Implements national policy
Oversees waiting lists and service targets
Supports workforce planning

Important 2025 Update

In 2025, the government announced plans to abolish NHS England and bring responsibilities back under DHSC control.

How it worked (before March 2025):

Taxpayer → DHSC (Wes Streeting) → NHS England (Mackey) → ICBs → NHS Trusts → Patient

How it works NOW (during 2025 transition):

Taxpayer → DHSC (Direct control) → ICBs → NHS Trusts → Patient
(NHS England is being bypassed and absorbed).

Local Level: Integrated Care Boards (ICBs)

Who is in charge locally? Your local ICB (e.g., "North West London ICB").
Role: They commission (buy) services for their local population. They now report directly to the DHSC, not via NHS England.
2025 Reality: ICBs have also been told to cut management costs by 50%.

Interview Insight

Possible reasons:

Reduce bureaucracy
Improve efficiency
Simplify leadership structures

Possible concerns:

Transition disruption
Loss of operational independence

5. Integrated Care Systems (ICSs)

Introduced officially in 2022.

Purpose

To improve coordination between:

Hospitals
GPs
Mental health services
Social care
Community care

ICS Structure

Integrated Care System (ICS) has:

Integrated Care Board (ICB)

Integrated Care Partnership (ICP)

Integrated Care Boards (ICBs)

Role

Plan healthcare locally
Allocate budgets
Commission services
Reduce regional health inequalities

Interview Phrase

“ICBs aim to tailor healthcare services to the specific needs of local populations.”

Integrated Care Partnerships (ICPs)

Role

Work with:

Councils
Community groups
Charities
Social care services

Goal:

Improve population health
Address social determinants of health

6. NHS Trusts vs Foundation Trusts

NHS Trust	Foundation Trust
Managed centrally	More independent
Less financial freedom	Greater financial autonomy
Deliver healthcare services	Deliver healthcare services
Accountable nationally	Accountable locally

Diagram: How Funding Flows

Taxpayers

↓

Treasury

↓

DHSC

↓

NHS England

↓

ICBs

↓

Hospitals / GPs / Community Services

↓

Patient Care

7. How the NHS is Funded

Main Sources

General Taxation

Largest source of funding.

Examples:

Income tax
VAT
Corporation tax

National Insurance Contributions (NICs)

Smaller Sources

Prescription charges
Dental fees
Parking charges

NHS Funding Breakdown (Approximate)

General Taxation ████████████████████ 80%

National Insurance ██████ 15%

Patient Charges ██ 5%

8. NICE (National Institute for Health and Care Excellence)

Main Role

NICE determines:

Which treatments are cost-effective
Which drugs should be funded
Clinical guidelines

QALY Concept

Quality Adjusted Life Year (QALY)

Used to assess:

Cost vs benefit of treatment

Example

Treatment A:

Costs £20,000
Gives 2 extra healthy years

Cost per QALY:
\frac{£20,000}{2}=£10,000\text{ per QALY}

NICE generally considers treatments cost-effective if below around £20,000–£30,000 per QALY.

9. Care Quality Commission (CQC) and other bodies

Role

Independent regulator of healthcare quality.

Inspects

Hospitals
GP surgeries
Care homes
Dental practices

CQC Ratings

Outstanding

Good

Requires Improvement

Inadequate

Key Bodies Still in Charge (Even after NHSE abolition)

These regulators and bodies continue to operate independently:

Body	Role	Why mention in interview
CQC (Care Quality Commission)	Inspects & rates hospitals (Outstanding to Inadequate).	Shows you understand quality assurance.
NICE (National Institute for Health and Care Excellence)	Decides which drugs/treatments are cost-effective (uses QALYs).	Essential for ethical funding discussions.
UKHSA (UK Health Security Agency)	Manages pandemics, infectious disease (replaced PHE).	Shows awareness of public health.
NHS England (in 2025)	Being abolished.	Only mention it to show you know the change.

10. NHS Timeline

Key NHS Reforms

1948 → NHS founded

1991 → GP fundholding introduced

2012 → Health & Social Care Act

2019 → NHS Long Term Plan

2022 → ICBs replace CCGs

2025 → NHS England abolition announced

11. Important NHS Interview Hot Topics (2025)

Waiting Lists

Over 7 million people waiting for treatment.

Causes

COVID backlog
Workforce shortages
Increased demand

Impact

Delayed diagnosis
Poorer outcomes
Staff burnout

Workforce Crisis

Key issues:

Staff shortages
Retention problems
Burnout
Industrial action

Mental Health Crisis

Challenges:

Long CAMHS waits
Lack of inpatient beds
Increased demand post-pandemic

Prevention vs Treatment

NHS increasingly focusing on:

Obesity prevention
Smoking cessation
Early diagnosis

12. NHS Digital Transformation

Examples

NHS App
Electronic patient records
AI diagnostics
Telemedicine

Benefits

Faster access
Better efficiency
Improved communication

Risks

Cybersecurity
Data privacy
Digital exclusion

13. Must-Know Facts for Your Interview

The £1bn Figure: The government claims abolishing NHS England will save £1bn annually, which will go directly to frontline patient care.
The 2022 Act: The Health and Care Act 2022 created ICBs (replacing CCGs). That was the last major reform before the 2025 abolition.
The Francis Report (2013): Always mention this when discussing NHS accountability. It highlighted catastrophic failures at Mid Staffordshire and led to a focus on compassionate, safe care – a reason why clear leadership structures matter.

14. Eleven Questions & Answers

Q1: “What are Integrated Care Systems?”

Answer

“Integrated Care Systems are partnerships between NHS organisations, local authorities, and community services designed to improve coordination of care. Their aim is to deliver more joined-up healthcare and reduce health inequalities.”

Q2: “How is the NHS funded?”

Answer

“The NHS is mainly funded through general taxation and National Insurance contributions, with a smaller amount from prescription and dental charges.”

Q3: “What does NICE do?”

Answer

“NICE provides evidence-based guidance and assesses whether treatments are clinically effective and cost-effective using measures such as QALYs.”

Q4: “What challenges does the NHS face?”

Answer Structure

Use:

Workforce shortages
Waiting lists
Ageing population
Mental health demand
Funding pressures

Then discuss:

Impact on patients
Possible solutions

Q5: "In your view, who has the most power in the NHS: the Secretary of State or the local GP?"

Answer:

"In 2025, the Secretary of State has more formal power because NHS England is being abolished, giving him direct control over funding and strategy. However, real-world power often lies with the local GP as the 'gatekeeper' to secondary care. A minister can set a target, but a GP controls the referral that meets it. The structural power is central; the clinical power is local."

Q6: "What is the biggest leadership challenge facing the NHS in 2025?"

Answer:

"The biggest challenge is managing the abolition of NHS England without destabilising frontline services. Staff are already exhausted. Adding a major reorganisation risks low morale and 'reorganisation fatigue'. The second challenge is financial: making the promised £1bn in savings from management cuts without affecting patient safety."

Q7: "Why was NHS England originally created, and why is it now being abolished?"

Answer:

"It was created after the 2012 Health and Social Care Act to give clinicians more autonomy and depoliticise day-to-day operations. It was meant to stop politicians interfering. However, over time, politicians felt they were blamed for failures but had no direct control. In 2025, Wes Streeting argues that the 'arms-length' distance just created bureaucracy, so he is bringing it back in-house for accountability."

Golden Interview Phrase

“The NHS is increasingly shifting from reactive treatment towards integrated, preventative, patient-centred care.”

Q8: "Is abolishing NHS England a good idea?"

Balanced Answer:

For (Govt argument): Reduces duplication. Ends "passing the buck" between DHSC and NHSE. Saves £1bn for frontline care. Increases ministerial accountability (voters know who to blame).
Against (Critics' argument): Politicises the NHS (politicians now directly control operations). Risk of "distraction" during transition. Loss of independent expert advice. 15,000 staff facing uncertainty.

Your conclusion (suggested): "The principle of reducing bureaucracy is sound, but the risk is that a major reorganisation distracts from the real crisis: staff burnout and waiting lists. Success depends on whether the £1bn savings actually reach the ward."

Q9: "Who is accountable if my local A&E fails?"

Answer:

Local: The NHS Trust CEO (runs the hospital) and the ICB (commissioned the service).
Regional: The regional director of the new unified DHSC.
National: The Secretary of State (Wes Streeting) – because in 2025, he has direct operational control.
Regulator: The CQC (gives the rating – Outstanding to Inadequate).

Q10: "How does funding flow from taxpayer to doctor?"

Answer:

The Pathway :

Tax & NI → Government.
Treasury allocates to DHSC (Wes Streeting).
DHSC directly allocates to ICBs (via a funding formula based on population need).
ICBs commission (pay) NHS Trusts & Foundation Trusts.
Trusts pay doctors' salaries and run hospitals.

Q11. Excellent Final Interview Statement

Answer:

“Why is understanding NHS structure important?”

“Understanding NHS structure is important because healthcare professionals work within complex multidisciplinary systems. Knowing how services are commissioned, funded, regulated, and integrated helps clinicians advocate for patients effectively and understand how healthcare decisions impact patient outcomes.”

15. High-Level Interview Tips

What Interviewers Want

Understanding of NHS structure
Awareness of current issues
Teamwork understanding
Patient-centred thinking
Communication skills

16. Quick Revision Summary

Remember These Key Organisations

Organisation	Role
DHSC	National health policy
NHS England	National NHS management
ICBs	Local healthcare planning
NICE	Cost-effectiveness guidance
CQC	Quality inspection
NHS Trusts	Deliver care