NHS #2 The new structure

At the top of the new pyramid sits the National Health Service Commissioning Board (NHSCB). This is an arms-length body of the Department of Health responsible for spending the £95.6 billion budget of the NHS. Actually, it has now changed its name to ‘NHS England’ – the reasons for this change are set out in this letter from NHSCB to the Secretary of State – so if you see any reference to NHSCB or NHS England, it should be taken as meaning the same thing.

Primary Care Trusts have been abolished and their staff have been moved across to local authorities and 19 regional Commissioning Support Units (CSUs). Or made redundant. In theory, decisions about the provision of services in your area will now be made by Clinical Commissioning Groups (CCGs). These are local groups made up of representatives of every GP practice in the area, a nurse, a hospital doctor and other healthcare practitioners. In practice, many decisions will still be made centrally by NHS England or one of its 27 Local Area Teams (LATs).

The NHS Information Centre – up until now principally a statistical data warehouse – has been renamed the Health and Social Care Information Centre (HSCIC) that is now to act as a ‘hub’ for data flows inside and out of the NHS.

As the legislation shows, the HSCIC:

  • can be directed by NHS England (or the Secretary of State) ‘…to establish and operate a system for the collection or analysis of information of a description specified in the direction.’  (s254)
  • can require health and social care bodies, and any of their sub-contractors, to provide it ‘with any information which the Centre considers it necessary or expedient for the Centre to have…’ (s259)
  • can request information from anyone else
  • must publish statistical information that does not identify individuals and
  • ‘may disseminate (other than by way of publication), to any such persons and in such form and manner and at such times, as it considers appropriate’ any other information – including identifiable patient information – that it receives (s261)

The National Information Governance Board (NIGB) – the independent statutory body responsible for data handling procedures and practices across the NHS – has been abolished, leaving responsibility for how your confidential information is treated spread across a number of different groups: the Confidentiality Advisory Group (CAG), the Data Access Advisory Group (DAAG) and other Independent Advisory Groups, such as GPES IAG*. You will need more information about how the new structure works in order to understand their functions, so we will deal with them later.

For further reading about the changes, you may find this BMA explanation helpful.
An overview of the current trusts and authorities in the English NHS can be found here.

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*@Bigjoe498 adds: The Confidentiality Advisory Group and the Health Research Authority are the only ones that can advise the Secretary of State to grant s251 approval for the release of identifiable data. The Data Access Advisory Group only deals with sensitive data items, which for HES (Hospital Episode Statistics) includes things like consultant code, referrer and census area. DAAG also look at consent forms to make sure they are explicit enough to release identifiable data for those who have consented using each form. The GPES Independent Advisory Group only advises the HSCIC about whether they should allow an extraction of GP data using GPES. The IAG has no standing in law to decide whether or not identifiable data can be shared outside the HSCIC.