http://www.nhs.uk/ServiceDirectories/Pages/StrategicHealthAuthorityListing.aspx
Acute trusts
Hospitals are managed by acute trusts, which make sure that hospitals provide high-quality healthcare, and that they spend their money efficiently. They also decide on a 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, psychologists and healthcare scientists. There are many other non-medical staff 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 can also provide services in the community, for example through health centres, clinics or in people's homes.
Foundation trusts
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 and have come to represent the government’s commitment to de-centralising the control of public services. These trusts remain within the NHS and its performance inspection system.
They were first introduced in April 2004, and there are now 115 foundation trusts in England.
Ambulance trusts
There are currently 12 ambulance services covering England, providing emergency access to healthcare.
If you call for an emergency ambulance the calls are prioritised into:
- Category A emergencies, which are immediately life-threatening, or
- Category B or C emergencies, which are not life-threatening.
The emergency control room decides what kind of response is needed and whether an ambulance is required. For all three types of emergency, they may send a rapid-response vehicle, crewed by a paramedic and equipped to provide treatment at the scene of an incident. Over the past five years the number of ambulance 999 calls has gone up by a third.
The NHS is also responsible for providing transport to get many patients to hospital for treatment. In many areas it is the ambulance trust that provides this service.
Care trusts
Care trusts are organisations that work in both health and social care. They may carry out a range of services, including social care, mental health services or primary care services.
Care trusts are set up when the NHS and local authorities agree to work together, usually where it is felt that a closer relationship between health and social care is needed or would benefit local care services.
At the moment there are only a small number of care trusts, though more will be set up in the future.
Primary care trusts
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 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). There are currently 152 PCTs in England.
Your PCT will work with local authorities and other agencies that provide health and social care locally to make sure that your 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.
For example, your PCT must make sure there are enough services for people within their area and that these services are accessible. It 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. They are also responsible for getting health and social care systems working together for the benefit of patients.
Mental health trusts
There are currently 60 mental health trusts covering England, which provide health and social care services for people with mental health problems. Mental health services can be provided through your 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. Services range from psychological therapy, through to very specialist medical and training services for people with severe mental health problems. About two in every 1,000 people need specialist care for conditions such as severe anxiety problems or psychotic illness.
Strategic health authorities
Created by the government in 2002 to manage the local NHS on behalf of the secretary of state, 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.
Strategic health authorities are responsible 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, and
- making sure national priorities - for example, programmes for improving cancer services - are integrated into local health service plans.
Strategic health authorities manage the NHS locally and are a key link between the Department of Health and the NHS.
Download a map of the SHAs (PDF)
Special health authorities
Special health authorities are health authorities that provide a health service to the whole of England, not just to a local community – for example, the National Blood Authority.
They have been set up to provide a national service to the NHS or the public, under section 11 of the NHS Act 1977. They are independent, but can be subject to ministerial direction like other NHS bodies.
PDF version NHS Northern trusts score well, while London falters
• MRSA reduction targets missed by most trusts
• NHS trusts: The strongest and the weakest (pdf)
The quality of NHS care in England has improved by leaps and bounds over the past two years, the independent health watchdog says today.
However, 60% of hospitals are still not dealing with superbug infections effectively, and 69% of GPs do not provide patients with the easy access to appointments that ministers want to see.
The mixed picture emerged in the Healthcare Commission's annual performance ratings for 391 NHS organisations. It said 62% of trusts were providing a good or excellent quality of service, compared with 41% two years ago. Financial performance improved even more sharply, with 69% getting high grades, compared with 16% two years ago.
Sir Ian Kennedy, the commission's chairman, said patients should celebrate the success of 42 trusts that received a "double excellent" rating, scoring top marks for both quality and finance. Last year there were 19, and just two in 2006.
Foundation hospitals did particularly well on the scoring system, which measures performance against dozens of criteria including patient satisfaction and achievement of government targets.
But serious weaknesses remain across much of the NHS. In the year to April a quarter of trusts failed to put in place adequate systems of infection control. Just over half did not achieve the government's target for reducing MRSA rates by 20% each year. Only 40% of trusts managed to introduce the right systems and hit the target.
Kennedy said trusts risked losing the licence to treat patients if they did not achieve an adequate standard of hygiene before the end of March, when his inspectorate is due to be replaced by the Care Quality Commission.
Spot checks over the past year found serious breaches of hygiene regulations at four hospitals and minor lapses at almost every trust visited. Inspectors will now begin a programme of spot checks of primary care, ambulance services and mental health trusts.
Anna Walker, the commission's chief executive, said tackling MRSA and C difficile was not enough. Trusts should monitor other infections including norovirus, a vomiting disease that strikes in winter.
She noted "a dramatic decline" in the number of primary care trusts meeting the target that every patient should be able to see a GP within two working days. This year 31% of practices met the target, compared with 80% last year.
The change was due to a new sampling method that asked thousands of patients about their experiences of trying to get an appointment, instead of relying on information from GP practices.
Dr Hamish Meldrum, chairman of the British Medical Association, said the report was misleading about GP waiting times. He said "A recent survey showed almost nine out of 10 patients were satisfied that they were able to get an appointment within 48 hours."
Gary Needle, the commission's head of assessment, said it could not be ruled out that GPs had been lying about how well they conformed to the target.
The commission congratulated hospitals for cuts in waiting times for cancer patients and for making good progress towards treating all patients within 18 weeks of referral by a GP.
Ambulances reached 77% of life threatening emergencies within eight minutes, exceeding the government's target of 75%. And mental health trusts helped thousands of patients by providing more crisis resolution teams in the community.
Trusts in northern England got the highest grades across all services, while standards in London fell well below average.
Alan Johnson, the health secretary, wrote to congratulate 57 high-performing trusts and told six "double weak" trusts to meet his officials to explain themselves.
Nearly 1,200 dentists in England and Wales earned over £200,000 in the financial year 2007-08, official figures show.
The NHS Information Centre statistics show 382 dentists - nearly 2% of the total - earned more than £300,000 in the year.
Average take home pay for the 19,586 registered dentists was £89,062.
The Liberal Democrats said the figures would "astonish people" who were still seeking NHS dental care.
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DENTISTS' EARNINGS
More than £300,000: 382
£275,000-£300,000: 113
£250,000-£275,000: 159
£225,000-£250,000: 228
£200,000-£225,000: 291
£100,000-£200,000: 4,418
£50,000-£100,000: 8,699
Figures for taxable income, after expenses have been deducted
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The figures cover earnings in the second year of the new contractual system for dentists.
However, the NHS Information Centre said they could not be compared with the previous year's earnings, which were calculated differently.
Chief executive Tim Straughan, said dentists' earnings varied greatly.
Dentists running their own practices who had a contract with the local primary care organisation to provide NHS services earned on average £126,807.
But dentists working in a practice without such a contract earned on average £65,697.
Since the start of the 1990s dentists have been increasing the amount of private work they do, resulting in problems for many people in accessing NHS services.
As a result, the government introduced the new contract in April 2006 in a bid to improve NHS access.
The aim was to end the "drill and fill" culture, which critics said had developed because dentists were paid for each individual treatment they carried out.
Under the new system dentists are paid for agreeing to do a set amount of courses of treatment over a year.
It was structured so that dentists would get the same amount of money for treating slightly fewer patients.
However, further tweaks to the contract are now planned after ministers accepted that their reforms had failed to improve patient access as hoped.
Working hard
John Milne, chair of the British Dental Association's general dental practice committee, said: "These statistics reflect a time when dentists were working hard to overcome problems with the new arrangements and make them work for their patients.
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 The amount of money some dentists are earning is staggering  Norman Lamb
Liberal Democrats |
"Many practitioners were contending with the uncertainty of potential clawback of their contract values.
"Dentists, almost uniquely in the NHS, carry the business risk of their surgeries and are responsible for providing premises, equipment and staff.
"The picture the statistics paint is one of earnings settling and the expenses of NHS practitioners rising slightly, although, as the Information Centre itself points out, it is hard to make comparisons with figures from previous years."
Norman Lamb, health spokesperson for the Liberal Democrats, said: "These figures will astonish people who are struggling to find an NHS dentist.
"The amount of money some dentists are earning is staggering.
"It is vital that the NHS can compete with the private sector to secure the best staff.
"However, we need to know that we are getting value for money."
Health minister Ann Keen said: "NHS dentistry is improving and many dentists are now keen to expand their NHS work.
"Today's report confirms that NHS dentists have good levels of earnings.
"Access to NHS dentistry is continuing to improve, following record investment, an expanding workforce and a continuing increase in the amount of services being bought by the NHS."
http://news.bbc.co.uk/1/hi/health/8183788.stm
Slashing spending on NHS quangos and capping the pay of health service managers could save £500m a year, the Lib Dems have argued.
Outlining savings in the health budget, spokesman Norman Lamb said he would "wield the axe" on quangos but protect front-line clinical services.
He told the party's conference the NHS had become a "bureaucratic monster"
The Lib Dems plan to recruit an extra 3,000 midwives while giving ward sisters power to set their own budgets.
Unlike the Conservatives, who have said they would ring-fence health from any budget cuts, the Lib Dems say the NHS cannot be immune from the drive to make substantial savings across government and the public sector.
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The Liberal Democrat message is to get rid of nanny and put sister in charge Norman Lamb MP
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However, the party says its focus is on cutting bureaucracy and simplifying structures within the NHS, thus freeing up money to invest in frontline staff.
'Get rid of nanny'
Its proposals would see strategic health authorities scrapped and the Department of Health downsized.
The annual budget for health quangos - which it say now tops £1.2bn - will be cut by 20%, with no quango boss being paid more than the prime minister.
It also says savings can be made in the way that hospitals are paid for operations.
The party pledges to tackle a "shortfall" in midwives and health visitors to guarantee any woman can give birth where she chooses while giving sisters in hospitals responsibility for staff budgets, ward cleanliness and patients' food.
"Rather than dictating to experienced NHS staff about how to improve our hospitals, we should listen to what they have to say," Mr Lamb said.
"The Liberal Democrat message is to get rid of nanny and put sister in charge."
http://news.bbc.co.uk/1/hi/uk_politics/8265373.stm
The HIV consortium is responsible for providing HIV treatment and care services for adults, young people and children living with HIV. The consortium commissions treatment and care on behalf of the 31 London PCTs for their residents. The 24 London providers commissioned by the consortium provide treatment and care for patients as at March 2007, 73% of whom are prescribed antiretrovirals - ARVs (drugs that work against HIV). We commission out-patient care from all 24 providers and in-patient and day care from nine providers. Care is initiated at the point of diagnosis and referrals are made from a variety of sources, including, but not limited to, sexual health services. 65% of the consortium’s budget is allocated to antiretroviral expenditure. Initiation of antiretroviral treatment, patient monitoring and support are key features of HIV service delivery. In keeping with the move to care closer to home, the year saw a rapid expansion in home delivery - 23% of the consortium’s patients now receive their ARV drugs through this scheme. The scheme has a number of advantages including time saving and convenience for patients as well as reducing pressure on hospital pharmacies. HIV services are characterised by high levels of patient and public engagement. The HIV Consortium has an active PPE sub group and patients routinely attend the main consortium and its sub group meetings. For example, PPE involvement in the drugs and treatment sub group ensures the patient’s voice is heard when the consortium is reviewing new ARV drugs and decisions are taken on their introduction into the consortium. The consortium also involved PPE representatives in its work on mapping patient pathways and developing associated quality standards.
http://www.londonspecialisedcommissioning.nhs.uk/specialisedservices/ind...
http://www.londonspecialisedcommissioning.nhs.uk/index.asp
Numbers accessing HIV care - http://www.hpa.org.uk/webw/HPAweb&Page&HPAwebAutoListDate/Page/1201094588844?p=1201094588844
Local Authority
http://www.hpa.org.uk/web/HPAwebFile/HPAweb_C/1228207184991
PCT
http://www.hpa.org.uk/web/HPAwebFile/HPAweb_C/1228207185359