Support - NHS explained & glossary

Structures in detail

Department of Health

This is the department that supports the government to improve the health and well being of the population. The Department is responsible for

• setting overall direction and leading transformation of the NHS and social care
• setting national standards to improve quality of services
• securing resources and making investment decisions to ensure that the NHS and social care are able to deliver services.

Special Health Authorities

These are Health Authorities which provide a health service to the whole of England, not just to a local community - for example, the National Blood Authority.

Strategic Health Authorities

Strategic Health Authorities manage the NHS locally and are a key link between the Department of Health and the NHS.
They are resposible 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
• making sure national priorities - for example, programmes for improving cancer services - are integrated into local health service plans.

Primary Care Trusts (PCTs)

Primary Care Services (also known as Family Health Services)
are the services provided by GPs, dentists, pharmacists and opticians.
Primary Care is the care provided by people you normally see when you first have a health problem. It might be a visit to a doctor or dentist, an optician for an eye test, or a visit to a pharmacist. NHS Walk-in Centres, and the phone line service NHS Direct, are also part of primary care. All of these services are managed by the local Primary Care Trust (PCT).

GPs, dentists, opticians and pharmacists are ‘independent practitioners’ who work for the NHS through national contracts, held and administered locally by Primary Care Trusts.

The PCT will work with local authorities and other agencies that provide health and social care locally to make sure that the local community's needs are being met. PCTs are now at the centre of the NHS and get 75% of the NHS budget.

NHS Acute Trusts

NHS Hospital Trusts, including NHS Foundation Trusts, provide mainly acute (short stay) services: medical, surgical, accident and emergency, outpatients, rehabilitation and maternity service, plus a range of specialist therapies: physiotherapy, speech and language therapy, podiatry and occupational therapy.

Day hospitals provide services, such as chiropody and occupational therapy, for elderly or mentally ill people to help them continue to live in the community.

Some Trusts are regional centres for specialised care: plastic or neurosurgery. Others are “supra- regional” centres of expertise: undertaking heart and liver transplants, eye and bone cancer treatments. Some are university teaching hospitals which train doctors, nurses and other health professionals and undertake research. Children's Hospitals are specialist centres with an environment designed especially for children's needs. Some rural areas have Community or local neighbourhood hospitals with fewer facilities. Many offer day surgery, outpatient clinics and maternity services.

Hospital Trusts usually have their own Departments of Psychiatry.

NHS Foundation Trusts

NHS Foundation Trusts 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 much more financial and operational freedom than other NHS Trusts. These Trusts remain within the NHS and its performance inspection system. There are currently 25 NHS Foundation Trusts in existence with another 10 seeking to become NHS Foundation Trusts from 1 April 2005. The next wave of Foundation trusts will include, for the first time, 8 Mental Health Trusts.

Mental Health Trusts provide health and social care services for people with mental health problems. Mental Health services can be provided through a GP, other primary care services, or through more specialist care. This might include counselling and other psychological therapies, community and family support, or general health screening. For example, people suffering bereavement, depression, stress or anxiety can get help from primary care or informal community support. If they need more involved support they can be referred for specialist care.

More specialist care is normally provided by Mental Health Trusts or local council social services departments.

Ambulance Trusts

There are 33 ambulance services covering England, which provide emergency access to health care, for example sending rapid response vehicles, crewed by paramedis, equipped to provide treatment at the scene of an accident.

The NHS is also responsible for providing transport to get patients to hospital for treatment. In many areas it is the Ambulance Trust which provides this service.

Next: Patient and Public Involvement (PPI) structures