NHS England and NHS Improvement

NHS England and NHS Improvement
Name	NHS England and NHS Improvement
Formation	2019 (merger of NHS England and NHS Improvement functions)
Type	Executive non-departmental public body
Headquarters	London
Region served	England
Leader title	Chief Executive
Parent organization	Department of Health and Social Care

NHS England and NHS Improvement

NHS England and NHS Improvement is the integrated executive arm responsible for overseeing the commissioning, regulation, performance oversight, and service improvement of the National Health Service in England. It evolved from the separate bodies NHS England and NHS Improvement to provide a single national leadership voice linking strategic commissioning, operational delivery, and financial oversight across NHS organisations. The organisation operates within the policy framework set by the Department of Health and Social Care and interacts with a range of public bodies including Public Health England, Care Quality Commission, and regional Integrated Care Systems.

History

The lineage of NHS England and NHS Improvement traces through reform milestones such as the NHS and Community Care Act 1990, the establishment of NHS England (formerly the NHS Commissioning Board), and the creation of Monitor (NHS) which later formed part of NHS Improvement. Major reorganisations include the implementation of the Health and Social Care Act 2012 and subsequent structural changes influenced by reports like the Five Year Forward View and the NHS Long Term Plan. The formal bringing together of strategic commissioning and regulatory improvement functions responded to pressures revealed during crises such as the Mid Staffordshire NHS Foundation Trust public inquiry and the operational demands of the COVID-19 pandemic in England.

Structure and governance

The organisation is led by a chief executive and board reporting within the framework set by the Secretary of State for Health and Social Care. Its governance arrangements reference arm’s-length bodies such as the Care Quality Commission and statutory bodies including NHS Trusts and NHS Foundation Trusts. Regional governance interacts with the network of Integrated Care Systems and Clinical Commissioning Groups legacy structures, while executive portfolios mirror themes from the NHS Constitution for England and national policy produced in collaboration with bodies like NICE and Public Health England.

Functions and responsibilities

NHS England and NHS Improvement carries responsibilities for national commissioning policy, specialised services, patient safety oversight, and system-level planning. It sets commissioning guidance that interacts with decisions by Clinical Commissioning Groups predecessors and regional commissioners, manages national procurement strategies similar to initiatives seen in NHS Supply Chain, and leads patient safety programmes connected to the Care Quality Commission regulatory framework. The organisation also oversees workforce planning in coordination with stakeholders such as Health Education England and workforce unions including the Royal College of Nursing and British Medical Association.

Relationship with NHS trusts and integrated care systems

Operational relationships are maintained through regulatory oversight of NHS Trusts, NHS Foundation Trusts, and local Integrated Care Systems which cluster providers and commissioners regionally. The body uses performance frameworks comparable to those applied by Monitor (NHS) to assess finance, access, and quality, intervening through provider boards or special measures when necessary, as in previous interventions at trusts like Mid Staffordshire NHS Foundation Trust or Basildon and Thurrock University Hospitals NHS Foundation Trust. Collaboration extends to partnerships with academic institutions such as King's College London, University College London, and University of Oxford on service redesign and research.

Funding and accountability

Funding flows derive from allocations set by the Department of Health and Social Care and are distributed to systems and specialised commissioning areas; accountability mechanisms include reporting to Parliament, interaction with the National Audit Office, and audit by bodies such as NHS Counter Fraud Authority. Financial regimes reflect austerity and investment cycles referenced in spending reviews overseen by the Treasury (United Kingdom), and performance against budgets is routinely scrutinised by select committees including the House of Commons Health and Social Care Committee.

Performance and policy initiatives

The organisation leads national initiatives such as implementation of the NHS Long Term Plan, elective backlog recovery post-COVID-19 pandemic in England, national digital transformation aligned to projects like NHS Digital, and patient safety alerts influenced by National Institute for Health and Care Excellence. Programmes include waiting time initiatives, diagnostic expansion, and workforce retention schemes often coordinated with bodies like Health Education England and professional colleges such as the Royal College of Surgeons of England.

Criticisms and controversies

NHS England and NHS Improvement has faced criticism over centralisation of decision-making, perceived tensions between regulator and commissioner roles, and responses to high-profile failures highlighted by inquiries such as the Mid Staffordshire NHS Foundation Trust public inquiry and reviews into pandemic preparedness. Controversy has also arisen around financial sustainability debates reported by the National Audit Office, disputes with trade unions like the Royal College of Nursing and Unison (trade union), and legal challenges brought under statutory duties governed by the Health and Social Care Act 2012.

Category:National Health Service (England) Category:Health care organisations based in the United Kingdom