NHS Financial, Legal and Regulatory Frameworks
How the NHS works now
The structure of the NHS changes frequently – the most notable recent example isthe decision abolish NHS England and integrate its functions into the Department for Health and Social Care. As such, we would advise caution when reading sources which have not been recently updated, as the information contained may be out of date.
The King’s Fund: This influential organisation promotes improvement in health and social care by providing insight, analysis and events. They have several excellent resources on how the NHS works, as well as up-to-date analysis of current issues in the NHS. Their ‘NHS in a nutshell’ series can be read here.
The Nuffield Trust: This organisation provides research and commentary on health and social care. There are a number of useful resources arranged by topic which can be found here.
The Structure of the NHS in England Research Briefing: This document, published in 2023 in the House of Commons Library and accessible here, provides an overview of how the NHS in England functions. It also highlights key issues facing the NHS including patient safety and performance challenges. Note as NHS England becomes integrated into DHSC from 2025-2027, this is likely to change significantly.
NHS Finance Explained: This 7 minute video by One NHS Finance, accessible here, explains the flow of funding in the NHS in England. As part of this, it clearly explains the structure of the NHS in England as it was in 2023,and particularly focuses on what has changed since the Health and Social Care Act of 2022. Note as NHS England becomes integrated into DHSC from 2025-2027, this is likely to change significantly.
How the NHS will work in the future and current ‘hot topics’
Integration of NHS England into DHSC and reforms to Integrated Care Boards: In March 2025 it was announced that NHS England would be integrated into the Department for Health and Social Care and would be fully abolished after 2 years, with a reduction in staff of 50% across the two organisations. Other changes to the structure of the NHS include the decision to cut the running costs of Integrated Care Boards by 50%. The rationale behind these decisions is explained and discussed in this King’s Fund blog post, accessible here.
The government’s 10-year plan: This summary by the King’s Fund, accessible here, brings together resources on the three ‘big shifts’ the Starmer government want to see in health and care over the next 10 years: from hospital to community services, from treating sickness to preventing it, and from analogue to digital.
Darzi report: This report on the state of the NHS in England was commissioned by Wes Streeting, the Secretary of State for Health and Social Care and conducted by Lord Ara Darzi. Its findings were published in September 2024 and can be found here. The report provides insight into the current challenges facing the NHS, as well as the likely priorities for the Labour government going forward.