Introduction to health services

The structure of healthcare in England

As you navigate healthcare services, it can be useful to know how the system’s structure and which organisation is ultimately responsible for the services your child receives.

Big changes are happening in the structure of the NHS in England at the moment. This means that some of the terms you might be familiar with have changed. Watch a short Kings Fund animation on changes happening in the NHS.

NHS England

NHS England is the body that leads the NHS. It promotes health and care for all. It helps NHS organisations work in partnership to deliver continuous improvement; better outcomes for patients and communities; and value for money for taxpayers.

Read more about NHS England.

NHS regions

NHS England has seven regional teams that support new integrated care systems (see below) to provide more joined-up care. They are responsible for the quality and financial performance of all NHS organisations in their area. 

Read more about NHS regions and find your regional team.

Integrated care systems (ICS)

Integrated care systems (ICS) are partnerships of organisations that come together to plan and deliver joined-up health and care services.

ICS are made up of:

• Integrated care board (ICB).
• Integrated care partnership (ICP).
• Primary Care Networks (PCNs).
• Provider Collaboratives.
• Place-based partnerships.
• Health and Wellbeing Boards

There are 42 ICSs spanning the whole of England.

See a King’s Fund diagram showing how the different components of ICSs work together.

What is the integrated care board?

On 1 July 2022, the Health and Care Act legally established integrated care boards (ICBs) in each of the 42 geographical areas. These replaced the 106 clinical commissioning groups (CCGs) that previously ‘bought’ and planned healthcare for local people.

The ICB is the body legally responsible for planning how to meet the health needs of people in the area. ICBs manage a share of the NHS budget and arrange local health services.

ICBs look after large populations, typically 1-3 million people. The former CCGs that commissioned healthcare typically did so for around 200,000 people each.

Find your local ICB.

What is the integrated care partnership?

The integrated care partnership (ICP) is a joint committee formed of the integrated care board (ICB) and the local authorities in the integrated care system (ICS) area. It brings together the NHS and local authority leaders to better integrate health (NHS), social care (local authorities) and wellbeing services.

The ICP is a broad alliance of partners involved in improving care, health and wellbeing of people in the ICS. Its main job is to produce a strategy – a type of long-term plan – on how to improve the health and wellbeing of people living in the ICS.

What are primary care networks?

Primary Care Networks (PCNs) are groups of general practitioners (GPs) who work together to provide a wider range of services to patients across the network.

Each PCN covers 30,000 to 50,000 patients. NHS England wants PCNs to offer more care locally so that patients don’t need to attend so many hospital outpatient appointments.

PCNs allow GPS to offer patients a wider range of services, lsuch as physiotherapy, social prescribing and more efficient access to community mental health teams.

What are Provider Collaboratives ?

These are partnerships that bring together two or more NHS trusts, including NHS hospitals and mental health services, to work together for the benefit of their patients and populations.

Collaboratives encourage health services and hospitals to work together rather than compete for resources and patients. Some of the more advanced collaboratives are for specialist mental health, learning disability and autism services.

See a list of all NHS Trusts and a list of all Provider Collaboratives.

What is a place-based partnership?

These are committees that lead detailed design and delivery of integrated health and care services across a smaller area within the integrated care system ICS. In most cases, ‘places’ will have the same boundaries as the local authority.

Place-based partnerships include NHS executives, local councils, community and voluntary organisations, residents, people who use services, carers and other community partners focussed on people’s health and wellbeing.

Read more about place-based partnerships.

What are Health and Wellbeing boards?

These are formal local authority committees involving key political, professional, clinical and community leaders. 

They have a statutory duty to assess and plan for the needs of their local population to address health inequalities and lead Place Partnerships. 

Integrated care boards and integrated care partnerships must have regard to Health and Wellbeing Board assessments and plans when making funding decisions.

UK Health Security Agency (UKHSA)

This ‘executive agency’ replaced Public Health England in 2021. The agency is responsible for protecting people from health threats. This includes the impact of infectious disease and chemical, biological and nuclear incidents. It is sponsored by the Department of Health and Social Care.

Read more about the UKHSA.

Local authority health responsibilities

Local authorities receive money from the Department of Health and Social Care (DHSC – see below) to help local people stay well mentally and physically. This includes weight management and stop smoking services. Local authorities also run most sexual health and drug and alcohol misuse services.

Department of Health and Social Care (DHSC)

The DHSC is the government department that advises ministers on shaping health and social care policies and legislation.

The DHSC holds NHS England and 23 other agencies and public bodies to account for delivering government policy.

Read more about the DHSC.

How to access health services

Primary care services

GPs, dentists, health visitors and opticians are part of what is known as primary care. These are health services you access directly without a referral.

Under the new integrated care systems (ICS – see above), most GPs have organised themselves into primary care networks (PCNs) with other GPs in the local area.

Read more about primary care services.

Secondary and tertiary care

Secondary care describes the sort of services you might be referred to if your child needs to be seen by someone with more specialist knowledge. Tertiary care is the specialist end of the NHS, and you might use these services if your child has a very complex or rare condition.

NHS 111

NHS 111 is an NHS phone service that will give you advice and will direct you to the most appropriate service.

The structure of healthcare in Northern Ireland

In Northern Ireland, health (and social care) services are provided by Health and Social Care (HSC) Trusts.

There are five HSC Trust areas: Belfast HSC Trust, Northern HSC Trust, South Eastern HSC Trust, Southern HSC Trust and Western HSC Trust. The sixth trust is the Northern Ireland Ambulance service, which covers the whole of the country.

The trusts’ aim is to improve health and social wellbeing, reducing health inequalities for those it provides it for. Trusts oversee hospitals, GP surgeries, and other family services such as pharmacies.

What healthcare services are available?

Health services your child might come to use include:

• Paediatrics / nurses.
• Learning disability teams.
• Physiotherapy.
• Dietary care.
• Dental services.

Your child might also be referred to various medical consultants for further treatment.

Accessing health services

Health services for disabled children can begin from birth or following diagnosis of a disability or condition. Initially, a disabled child might be referred for health services by a Health Visitor, a GP or by the parent themselves.

Health and Social Care trusts differ in their referral systems for the services they provide. For example, your child’s GP might refer them to a paediatrics service or a child development centre, and onto a physiotherapist or genetic services.

These referrals will result in a named worker who will pass information to families and back to other involved services.

More information

Read more about healthcare in Northern Ireland at nidirect.

The structure of healthcare in Scotland

Integrated health and social care

In 2016, the Scottish Government brought health and social care together in to a single, integrated system. The aim is to improve care and support for people who use services, their carers and their families. 

There is greater emphasis on joining up services and focusing on early intervention and preventative care.  More focus has also been placed on health care destinations and support for children and young people and those who care for them. 

Local integration authorities

The legislation that brought health and social care together also created 31 integration authorities. These are required to work with their local communities and providers of care to ensure care is responsive to people’s needs. 

Each of the 31 health and social care partnerships across Scotland has a unique set of integration arrangements. A list of the 31 integration authorities and their chief officers is on the Health and Social Care Scotland website.

Getting it Right for Every Child (GIRFEC)

In addition to this, the Scottish government published Getting It Right for Every Child (GIRFEC) in 2006. 

GIRFEC applies to all health, social care and education services for children in Scotland. It provides the policy framework for improving children’s wellbeing and improving outcomes for all children. It places the child at the centre of thinking, planning and action.

What services are available?

Health services your child might use include:

• Paediatrics / nurses.
• Learning disability teams.
• Physiotherapy.
• Dietary care.
• Dental services.

Child and adolescent mental health services (CAMHS) include staff who have specific experience and training in working with children and young people with Learning Disabilities and Neurodevelopmental Disorders. For more information, see the CAMHS national service specification.

Your child might also get a referral to other medical consultants for further treatment.

How to access services

Getting a diagnosis

Once you realise your child may have a learning difficulty or health concern, getting a diagnosis might be the next step.

There are many disabled children living without a diagnosis. If you care for a child without a diagnosis, you may worry that you won’t get any help or support. This is not the case. Read our information about support when your child does not have a diagnosis.

Our A-Z of medical conditions is a directory of reliable, medically approved information on more than 400 medical conditions, including rare syndromes, and support groups for them.

If you have concerns

If you have concerns about your child’s health or their development, talk to your GP or health visitor first.  See a list of health and wellbeing services in Scotland, including GP practices and hospitals.

Your GP or health visitor may refer you to a consultant or community paediatrician. They can provide an assessment, diagnosis and the follow-up you need. They can link you to wider professional support from allied health professionals (AHPs) like speech and language therapists and physiotherapists.

Help to access NHS services

Navigating NHS services can be quite challenging, particularly when a number of different professionals are involved.

The NHS Inform website, including a section for young people and helpline, has information on health, treatments, patient rights and long-term conditions.

Children’s Health Scotland is a charity dedicated to promoting and championing the needs of all children and young people and their families at times of illness. It provides a website offering information and advice and contact destinations for an extensive range of childhood conditions.

Our Contact Scotland By Your Side parent adviser is here to provide support to families attending hospital to make sure they have the right information they need.  Email [email protected] with your enquiry.

Other useful NHS information and contacts 

NHS inform is Scotland’s health information service. It offers quality assured health and care information via a website and phone service. 

Use NHS 111 for urgent care and advice when your GP, pharmacy or dental practice is closed.

For information about your rights when you use NHS services in Scotland, please read the Charter of Patient Rights and Responsibilities. This summarises what you are entitled to when you use NHS services and receive NHS care in Scotland, and what you can do if you feel that your rights have not been respected. An easy read version of the charter is also available. 

The structure of healthcare in Wales

NHS Wales delivers services through seven local health boards responsible for planning, delivering and commissioning NHS services in their areas.

They are also responsible for improving physical and mental health outcomes, promoting wellbeing and reducing health inequalities across their population.

In addition, there are three NHS trusts, including the Welsh Ambulance Services NHS Trust and Public Health Wales.

Accessing services

If you have concerns about your child’s health or development, talk to your GP or health visitor in the first instance. 

Health concerns can be identified during pregnancy, at birth, and at any age following an assessment and diagnosis of a disability or condition. Referral for further treatments can come from a health visitor, community nurse, GP or a parent themselves via their local authority.

You may be referred on to a consultant or community paediatrician who can provide assessment, diagnosis and follow-up as appropriate and link you to wider professional support, which can include speech and language therapists and physiotherapists.

More information about healthcare in Wales

Information about healthcare in Wales and health and wellbeing services is available at http://www.wales.nhs.uk/

NHS 111 Wales can give you quick and easy access to health advice and care – for example, a GP, nurse, pharmacist or a Minor Injury Unit – where you will often be seen far more quickly than in Accident & Emergency (A&E) departments, where only patients with major illnesses or injuries can be treated.

The following NHS 111 Wales resources might be helpful:

• NHS 111 Wales – Services near you.
• NHS 111 Wales – A-Z to find out more about illnesses, conditions, operations, tests and treatments. 
• NHS 111 Wales telephone service – For urgent but non-emergency health issues, with access to Language Line, Relay 24 and Interpreter Now.