In the last 20 years, the NHS in the UK has gone through a number of changes.
Since devolution in the late 1990s, the NHS is no longer one large body, responsible for the whole of the UK. Health and social care are now organised and funded by the devolved governments in Wales, Northern Ireland and Scotland. 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 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 service that you might recieve across the UK. For example, in Scotland, all social care over the age of 65 is free. In Scotland and Wales, prescriptions are free, whereas there is a means-tested charge in England.
Most local services for MS and other conditions are commissioned by Clinical Commissioning Groups. These are groups of GP practices which look at the needs of their patients, and make 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
There are around 200 CCGs in England, although some are currently in the process of merging. The full list of CCGs can be found on the NHS England website. The Nuffield Trust has produced a diagram showing the structure of the health and care services in England.
Some NHS care is too unusual to be commissioned at CCG level, and 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 opthalmologists
- 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.
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 Health Boards, covering all of Scotland. They take the role roughly equivalent to Clinical Commissioning Groups in England, in that they plan and deliver health services based on the needs of the local community.
Health Boards have responsibility for the protection and the improvement of their population's health and for the delivery of frontline healthcare services. In local areas, there may be community health and social care partnerships 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 which support the regional NHS Boards. They provide national services, including health education, public health, prison health services, 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.
Scotland has different prescribing rules for drugs and medicines to the rest of the UK. The Scottish Medicines Consortium guide the prescribing of drugs in Scotland, and have 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 drugs options available to them to residents elsewhere in the UK.
For NHS Wales, the Local Health Boards (LHBs) develop and provide health services based on the needs of the local community, much like CCGs in England. There are seven LHBs to cover Welsh regions, alongside three national NHS Trusts that cover the ambulance service, public health and specialist services for cancer. 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.
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. As such, people with MS in Wales may have access to different drug options to those elsewhere in the UK.
NHS Northern Ireland
In Northern Ireland, the National Health Service (NHS) is referred to as HSC or Health and Social Care. Just like the NHS is it 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.
There is one Health and Social Care Board (HSCB) that is responsible for assessing the health and social care needs of Northern Ireland, commissioning services to meet those needs and monitoring the performance of services. Its role is broadly equivalent to Clinical Commissioning Groups (CCGs) in England, and Health Boards in Scotland and Wales, but as well as commissioning health services it is also responsible for social services.
The HSCB has five Local Commissioning Groups (LCGs). Each LCG covers the same geographical area as their respective Health and Social Care (HSC) Trust. The Board is also directly responsible for managing contracts for the family health services provided by GPs, dentists, opticians and community pharmacists. These are all services not provided by Health and Social Care Trusts. While the Board commissions services, it’s the Trusts that actually provide them ‘on the ground’.
Integrated Care Partnerships (ICPs) operate in smaller regions than the HSC Trusts, linking up services including pharmacy, ambulance services, social work and nursing care. They are multidisciplinary teams that should ensure that each patient has to deal with fewer health professionals, and that their care happens near to their home in convenient locations.
The Department of Health in Northern Ireland usually accepts recommendations for drug prescribing from NICE, once funding implications have been assessed.
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Care in the NHS
Take a look at the route that a person with multiple sclerosis might take through healthcare services in the UK, beginning with a GP or nurse, and through to more specialist services.