Make DoH roles explicit: NHS headquarters and independent regulatory framework

The Index has not yet recorded a verbatim government response to this recommendation.

The Department of Health and Social Care’s role is to support and advise the Government’s health and social care ministers (including the Secretary of State) by shaping policy, assisting in the setting of the strategic direction for the health and care system and implementing agreed policy, often through oversight of its operational arm’s length bodies. The Department is responsible for overall health policy. NHS England has day-to-day responsibility for the NHS in England. The Department is accountable to Parliament for the use of funding that it secures for health and social care, which is allocated to the most appropriate level. The Department also oversees the legislative framework for the NHS and develops changes to that framework as required by policy or other drivers.

The Health and Social Care Act 2012 introduced a statutory requirement for the Secretary of State to set out objectives NHS England must seek to achieve in the exercise of its functions in a ‘mandate’. The mandate is the Government’s statutory mechanism for setting out the top strategic priorities and overall direction for NHS England, reviewing NHS England’s performance and progress towards these objectives as part of a broader assurance process and providing a transparent framework of expectations and objectives for both the public and the system. While initially legislation set out that this must be renewed annually the Health and Care Act 2022 removed this annual requirement to enable longer term planning for the NHS while also ensuring a document which can respond to changing need.

The NHS Oversight Framework sets out the national approach and processes by which NHS England oversees ICBs and NHS providers, and how performance is monitored against key NHS commitments.

NHS England holds regulatory powers which allows it to intervene and direct ICBs that are, or are at risk of, not discharging their duties properly, and to intervene and require remedial action by NHS providers that are, or are suspected of being, in breach of the conditions of their licence.

Care Quality Commission (CQC) monitor, inspect and regulate health and care services, which includes services provided by NHS trusts, to make sure they meet fundamental standards of quality and safety. To ensure alignment, CQC findings are factored in when NHS England makes decisions about performance of NHS providers.

The Government agreed with this recommendation.

In its January 2002 response, the Department of Health said it would be responsible for setting the overall direction for the NHS, securing its funding, determining major investments and ensuring that there are appropriate arrangements in place for its management, standard setting, inspection, improvement and accountability. The Department said it would be responsible for ensuring the various bodies responsible for these different functions worked together to provide a consistent framework of high delivery health improvement.