In the last 20 years, the NHS in the UK has gone through a number of changes and it is still evolving.
Since devolution in the late 1990s, the NHS is no longer one large body, responsible for the whole of the UK. NHS England leads the National Health Service in England, whilst the devolved governments in Wales, Northern Ireland and Scotland organise and fund their own health and care services. Some English regions also have responsibility for health and social care funding, including the city of Manchester and the county of Cornwall.
The hope is that through these changes, resources and services can be organised in the most effective way for each nation or region, although it can be confusing if you move between parts of the UK. In this page, we set out the current structure of health services in the UK, with particular reference to the services that you might need as a person with MS.
In general, the pathway that you take as a patient is the same everywhere in the UK. You start with a visit to a GP or other primary health care provider, and they refer you to other services as you need them. Health care is free at the point of service and funded by taxes.
There are differences in the services that you might receive across the UK. For example, in Scotland, all social care over the age of 65 is free. In Scotland, Wales and Northern Ireland, prescriptions are free, whereas there is a means-tested charge in England.
Until recently, most local services for MS and other conditions were commissioned by clinical commissioning groups (CCGs) – groups of GP practices which looked at the needs of their patients, and made a contract for services with other providers, such as:
- community and district nurses
- local physiotherapists and occupational therapists
- planned hospital care
- urgent and emergency care (including out-of-hours)
- mental health and learning disability services.
However, in July 2022 following recommendations from NHS England and the passing of the Health and Care Act (2022), 42 integrated care systems (ICSs) were established across England and CCGs were abolished.
ICSs are partnerships of NHS organisations, local authorities, community and voluntary organisations, local residents, service users and carers. Their role is to plan and deliver joined up health and care services in a particular area. You can find a full list of the ICBs and a map of the areas covered on the NHS England website.
As part of the ICSs, NHS England established 42 integrated care boards (ICBs). Each ICS has an ICB. The ICB is the NHS organisation responsible for developing a plan in partnership with NHS trusts/foundation trusts in the defined area to meet the health needs of the community, manage the NHS budget and provide health services.
Essentially ICBs have taken on the NHS planning functions previously carried out by CCGs.
Some NHS care is too specialised to be commissioned at the ICB level, and instead is commissioned centrally by NHS England. This includes:
- specialised services – important for MS as these include neurology services provided by teaching hospitals, known as adult neuroscience centres
- offender health – NHS services in prisons
- some primary care – GPs, NHS dentists, NHS ophthalmologists
- armed forces care
- some public health services, eg immunisations programmes, national screening programmes, sexual assault referral services.
In England, social care is provided by local councils. Some of these services can be important for people with MS, such as housing adaptations including equipment like grab rails. Local authorities also take on responsibility for some other public health services, such as healthy eating, smoking cessation, drug and alcohol misuse programmes.
Drug approval process
MS drugs and other treatments are evaluated by the National Institute for Health & Care Excellence (NICE). If they do not recommend a treatment, then local health authorities are not legally obliged to offer it.
In Scotland, health services are devolved to the Scottish Government. The Scottish NHS consists of 14 regional NHS Boards, covering all of Scotland. The NHS Boards plan and deliver health services based on the needs of the local community.
NHS Boards have responsibility for the protection and improvement of their population's health and for the delivery of frontline healthcare services. They plan and commission hospital and community health services, including services provided by independent contractors such as GPs, dentists, opticians, and community pharmacists.
At a local level, there are community health and social care partnerships (Integrated Joint Boards) which also provide services relevant to people with MS, as they link health care and social services.
Scotland also has seven special NHS Boards and one public health body (Public Health Scotland) which support the regional NHS Boards. They provide specialist and national services, including heart and lung services, health education, public health, prison health services, an out-of-hours telephone service, the ambulance service, health monitoring and blood transfusion services. The full list of Health Boards and special NHS Boards can be found on the NHS Scotland website.
Drug approval process
Scotland has different prescribing rules for drugs and medicines to the rest of the UK. The Scottish Medicines Consortium guides the prescribing of drugs in Scotland, and has different timescales and priorities to NICE, which provides the same service to England, Wales and Northern Ireland. As such, people with MS in Scotland may find they have a different suite of drug options available to them than residents elsewhere in the UK.
For NHS Wales, Local Health Boards (LHBs) develop and provide health services based on the needs of the local community within a geographical area. There are seven LHBs to cover the Welsh regions, alongside three national NHS Trusts that cover the ambulance service, public health (Public Health Wales) and specialist services for cancer and a range of national support services (Velindre NHS Trust). The full list of Trusts and LHBs shows the regions that each LHB is responsible for.
Public Health Wales organise and assess health campaigns in Wales, and also have links to partnership organisations.
There are also seven Community Health Councils (CHCs) in Wales, these are statutory lay bodies that represent the interests of the public in the health service in their region.
Drug approval process
NHS Wales normally follows the advice of NICE regarding prescription drugs and treatments, but it is also guided by the All Wales Medicines Strategy Group, which may in some case make a different recommendation to NICE. As such, people with MS in Wales may have access to different drug options to those elsewhere in the UK.
In Northern Ireland, the National Health Service (NHS) is referred to as HSC or Health and Social Care. Just like the NHS it is free at the point of delivery, but in Northern Ireland HSC also provides social care services like home care services, family and children's services, day care services and social work services, as well as policy and legislation for hospitals.
Until March 2022, there was one Health and Social Care Board (HSCB) that was responsible for assessing the health and social care needs of Northern Ireland, commissioning services to meet those needs and monitoring the performance of services. As well as commissioning health services it was also responsible for social services. Responsibility for its functions transferred to the Department of Health's Strategic Planning and Performance Group.
The HSCB had five Local Commissioning Groups (LCGs). Each LCG covered the same geographical area as their respective Health and Social Care (HSC) Trust. The Board was also directly responsible for managing contracts for the family health services provided by GPs, dentists, opticians, and community pharmacists – services not provided by Health and Social Care Trusts. While the Board commissioned services, it was the Trusts that actually provided them ‘on the ground’.
Integrated Care Partnerships (ICPs) operated in smaller regions than the HSC Trusts, linking up services including pharmacy, ambulance services, social work and nursing care. Their multidisciplinary teams ensured that each patient had to deal with fewer health professionals, and that their care happened near to their home in convenient locations.
However, there are major changes to health and social care services in Northern Ireland currently underway. As well as the HSCB being closed, a new Integrated Care System (ICS) is currently being developed.
The aim of the ICS approach is to bring together partners within the HSC, voluntary and community sectors, and local government to plan, manage and deliver services based on the needs of the local population. This model will see decision-making and funding made at a local level, with the exception of regional and specialist services.
ICS NI will be one planning system made up of component parts at both regional and local levels. At an area level, there will be five Area Integrated Partnership Boards (AIPBs). They will be responsible for planning and delivering improved health and social care outcomes for their communities. They’ll be made up of representatives from across health and social care, the voluntary and community sectors, local government, service users and carers.
Locality groups will aid AIPBs to assess the needs of their population and delivery of services. The number and make-up of the locality groups is still to be determined but they are likely to vary depending on the needs of a particular area.
Drug approval process
The Department of Health in Northern Ireland usually accepts recommendations for drug prescribing from NICE, once funding implications have been assessed.