On this page we’re giving an overview of how the health and care system is structured in each UK nation, and highlighting where hospices and palliative and end of life care providers can gain influence.
NHS in England – Integrated Care Systems
In July 2022, the NHS in England was restructured into 42 Integrated Care Systems (ICS).
These fall within the jurisdiction of the Department of Health and Social Care (DHSC) and are, in part, supported by NHS England (NHSE).
Within each ICS is an Integrated Care Board (ICB). The ICB has statutory responsibility and a budget allocation for planning and managing NHS services for a ‘system’ area of 1-3 million people.
The ICB is made up of:
- a Local Authority member
- members from constituent healthcare providers such as NHS Trusts and GP practice.
There will be sub-committees where decisions are made regarding specific areas of local or community care. One of these is the palliative and end of life care (PEoLC) board/committee. Groups of hospices and PEoLC providers should try to lead or be represented at this sub-committee.
Find a visual map of Integrated Care Systems in England.
An Integrated Care Partnership (ICP) brings together local authorities and wider health and care partners to produce the Integrated Care Strategy (the strategy that informs the ICB’s plans). The ICP is where the voluntary sector can have most influence.
In order to influence and engage with the ICS, NHS Trusts are forming Provider Alliances and the voluntary sector is forming VCSE partnerships to strengthen their voice and fully represent their sector.
‘Systems’ are made up of multiple ‘places’ of between 250,000 and 500,000 people. Partnerships for planning and delivery exist at this level as well as system level. These include GP Federations, Out of Hours services and wider ‘Place-based Partnerships’ for healthcare.
At ‘place’ level, local authority Health and Wellbeing Boards (HWB) are responsible for producing local strategies and assessing the needs of the local population by carrying out a Joint Strategic Needs Assessment (JSNA). The local JSNA is the key document guiding the priorities for at ‘place’ and ‘system’ level, so hospices and other PEoLC providers should ensure they feed into it.
At ‘neighbourhood’ level, GP practices work in Primary Care Networks (PCN), collaborating with a range of health and care services for their registered populations of 30-50,000 people. GPs hold the patient records and keep the end of life care patient registers so are vital partners in early identification of need and coordination of support for their patients.
Find out more about the policy and guidance underpinning England’s Integrated Care Systems.
HSC in Northern Ireland – Integrated Care System
Northern Ireland’s NHS is called Health and Social Care (HSC). In April 2022, the national HSC Board was dissolved and system oversight absorbed into the Department of Health.
A national Integrated Care System (ICS) is still planned to bring together the strategic planning of health and social care across the country.
The five existing Local Commissioning Groups (LCG) will transition into five Area Integrated Partnership Boards (AIPB). The AIPBs will bring together the commissioning function of the LCGs with the five HSC Trusts (which provide hospital, community and social care) and GP practice.
This should make the planning and provision of care more holistic and involve a wider group of partners from the voluntary and community sector.
As the decision-making responsibilities of the AIPBs emerge, palliative and end of life care (PEoLC) providers will need to gain membership and/or influence.
There are 17 GP Federations and Integrated Care Partnerships (ICP), which were set up in 2013. They will continue to work at locality level, providing services across primary, community and social care and working with local voluntary organisations and communities. Hospices will be linked in with these ICPs.
Find out more about the policy and guidance underpinning the HSC system in Northern Ireland.
NHS in Scotland – NHS Boards
Since 2004, NHSScotland has been structured as 14 regional NHS Boards, which plan, commission and deliver NHS services including hospital, community and primary care. They write strategic plans and report annual performance against a national outcomes framework.
There are also seven national Special NHS Boards with specific additional remits. All the Boards are directly accountable to Scottish Ministers.
NHS Boards and local authorities are required to delegate some planning and decision-making to 31 local committees called Health and Social Care Partnerships.
This ensures close working between the NHS, local authorities, the voluntary sector, patients and the public. These were mandated in 2014 and are mostly organised as Integration Joint Boards (IJB). The exception is Highland, where the NHS and the Council take lead roles for all adult and all children’s services respectively.
The Partnerships are mostly co-terminus with the local authorities, across a smaller geography than the NHS Boards, but they oversee and delegate health and social services work to both these bodies.
The Partnerships are where the voluntary sector can have most influence on setting system priorities. Having a voice within the NHS Boards will ensure palliative and end of life care is considered and funded as part of NHS service strategy and delivery.
Find out more about the policy and guidance for health and social care in Scotland.
NHS in Wales – Health Boards
In 2009, the Welsh Government restructured local healthcare planning and delivery into seven Local Health Boards (LHB) at regional level.
LHBs are directly responsible to the Welsh Government and the Director General for Health and Social Services is also the chief executive of NHS Wales.
LHBs must produce Integrated Medium Term Plans (IMTP) for health services across acute, community and primary care. Hospice expertise and services should be included in this planning process.
From 2016, Regional Partnership Boards (RPB) were introduced to bring the LHBs together with local authorities, the voluntary sector, patients and carers for wider health and care planning. They cover the same geographical area as the LHBs and are responsible for the regional population assessment and overseeing the LHB plans.
This is where the voluntary sector can articulate the needs and influence priority setting.
There are three national NHS Trusts in Wales, including one for cancer services and two Special Health Authorities.
During 2022, the chief executive of NHS Wales plans to establish an NHS Executive function to oversee the quality and outcomes of NHS services across the country.
Find out more about the policy and guidance for health care in Wales.
Supporting & improving quality of health services
Across the UK, the health and care systems have organisations that protect public health, provide health education and monitor quality of service. It is important to know who these are and what their remit is. This will give you an idea about what guides the decision-makers in your system.
Sometimes these organisations only cover NHS providers, and sometimes the whole health and care system. However the frameworks and programmes that begin in NHS hospitals are often rolled out to other providers, so it is worth being aware of them.
The UK Health Security Agency is part of Government and replaced Public Health England in October 2021. It produces guidelines and advice for issues such as disease outbreaks and vaccination campaigns.
Health Education England works with partners to plan, recruit, educate and train the health workforce. It is due to merge with NHS England (NHSE) during the 2022 restructure. It commissions the training places for university undergraduate and graduate medical and clinical students. Workforce recruitment and continuing professional development programmes also form part of its work.
The Care Quality Commission (CQC) is the independent regulator of health and social care in England. All providers of healthcare must register their regulated activities with the CQC and are regularly inspected against its quality framework.
By 2023, the current Healthcare Safety Investigation Branch will become the Health Services Safety Investigations Body (HSSIB) to provide fully independent investigation into any patient safety incidents.
The Public Health Agency is a part of Northern Ireland’s Health and Social Care (HSC) with a focus on public health and social wellbeing including reducing health inequalities.
Northern Ireland’s Department of Health’s Workforce Development is responsible for ensuring the HSC workforce is adequately trained and qualified. The Medical and Dental Training Agency supports clinical education through to recruitment.
The Regulation and Quality Improvement Authority is the independent body which registers, regulates and inspects all health and social care services in Northern Ireland.
Public Health Scotland is the lead Scottish body for improving and protecting health and well-being.
NHS Education for Scotland is the NHS education and training body and one of NHS Scotland’s Special NHS Boards.
Healthcare Improvement Scotland, another Special NHS Board, provides oversight and guidance for the quality and safety of healthcare services. This includes the registration and inspection of health providers, the patient safety programme, and evidence-based practice guidelines. The Care Inspectorate registers and inspects the quality of care services.
Public Health Wales is the NHS Trust that takes the lead to protect and improve health and wellbeing and reduce health inequalities.
Health Education and Improvement Wales is a Special Health Authority within NHS Wales dedicated to transforming the workforce through education, training and development.
Healthcare Inspectorate Wales is the independent inspectorate and regulator of healthcare in Wales. Care Inspectorate Wales is the independent inspectorate and regulator of social care services in Wales.