UK health systems
The four countries that make up the UK – England, Wales, Scotland and Northern Ireland - have slightly different health systems.
Click on the links below to see information about how the four systems operate and the differences between them.
- England Expand / Collapse
Health services in England are centrally funded from the Department of Health, based on a set tariff per patient and type of treatment.
The NHS provides healthcare services through NHS trusts, foundation trusts (including mental health and ambulance trusts), as well as some charities and social enterprises. All GPs in England are part of a clinical commissioning group which is responsible for planning and commissioning (buying) the services their patients need.
A national body - NHS England - oversees the NHS commissioning budget of approximately £80 billion and its area teams are responsible for commissioning the following:
- some optical services.
NHS England’s area teams also have overall responsibility for screening and immunisation programmes.
Public health in England
Public health services in England are primarily delivered through:
- Public Health England
- local authorities that have public health responsibilities
Public Health England was formed in 2013. Its mission is to protect and improve the nation's health and wellbeing, and reduce health inequalities.
The Health and Social Care Act 2012 gave some local authorities mandatory requirements for commissioning public health services such as sexual health, NHS health checks and the National Child Measurement Programme, and for providing public health advice through clinical commissioning groups. Each such local authority has a health and wellbeing board which sets the local strategic direction for public health and a strategy based on the needs of the local population.
Local authorities also have statutory responsibilities to ensure systems are in place to protect the health of the population and to provide information and advice in the event of a health protection incident or outbreak.
- Wales Expand / Collapse
As a devolved administration, Wales receives a block grant from the UK central government which is then distributed between the different departments, including NHS Wales. The main difference for patients in Wales is that prescriptions for medicines are free for everyone.
Health services in Wales are delivered through seven health boards and three NHS trusts, each one responsible for delivering all healthcare services within a particular geographical area. The three NHS trusts in Wales with an all-Wales focus are:
- The Welsh Ambulance Services Trust for emergency services
- Velindre NHS Trust which offers specialist services in cancer care
- Public Health Wales
The seven health boards work together with community health councils which represent patients and user groups.
Public health in Wales
Public Health Wales make a commitment to:
- improving health and reducing health inequalities
- improving the quality, equity and effectiveness of services
- protecting people from infectious and environmental hazards
Each of the seven health boards in Wales has a director of public health who works closely with Public Health Wales. The directors of public health are responsible for providing professional advice and leadership within their health boards and for working in partnership with their related local authorities.
- Scotland Expand / Collapse
As a devolved administration, Scotland receives a block grant from the UK central government which is then distributed between the different departments, including NHSScotland.
NHSScotland is made up of 14 health boards which are responsible for delivering the acute and primary healthcare services their populations need. There are also eight special health boards that cover services such as ambulance services, Scotland’s health improvement agency (called NHS Health Scotland) and NHS Education for Scotland. They also have their own careers website.
Public health in Scotland
Each health board has a public health department where responsibility lies for monitoring and improving the health of their populations.
NHS Health Scotland is one of the special health boards and its overall aim is to improve Scotland’s health by focusing on the inequalities that prevent health being improved by all. NHS Health Scotland is the main health improvement agency in Scotland and covers every aspect of health improvement across all health topics, settings and life stages.
More than 50 organisations are involved in health protection in Scotland over two ‘tiers’:
- local authorities and NHS boards
- Government, NHS special boards, Scottish Environment Protection Agency, Scottish Water, the Food Standards Agency and the Health and Safety Executive
Health protection in Scotland
Health Protection Scotland provides advice and services to the rest of NHS Scotland. It:
- provides the national blood transfusion service
- provides advice on healthcare environments and equipment
- monitors hazards and exposures affecting people’s health
- provides guidance on tackling healthcare associated infections
- coordinates screening programmes
- Northern Ireland Expand / Collapse
The health system differs in Northern Ireland in that both health and social care are provided through an integrated service and prescriptions for medical care are free for everyone.
Northern Ireland receives a block grant from the UK Treasury which funds the Department of Health, Social Services and Public Safety for Northern Ireland (DHSSPS). The DHSSPS has overall responsibility for providing health and social care services in Northern Ireland, including public health and public safety.
Health and Social Care Board
Working under the DHSSPS, a Health and Social Care Board is responsible for:
- commissioning services
- resource management
- performance management
- service improvement
The Health and Social Care Board works to identify and meet the needs of the Northern Ireland population through its five local commissioning groups. The local commissioning groups cover the same geographical areas as five health and social care trusts that deliver health and social care services. A separate trust - Northern Ireland Ambulance Trust – provides ambulance services across Northern Ireland.
Public health in Northern Ireland
The Public Health Agency (PHA) is responsible for:
- health protection
- health and social care research and development
- safety and quality
- improving health and social wellbeing
It also provides public health, nursing and allied health professional advice to support the Health and Social Care Board and its local commissioning groups.