Monitoring the NHS

oPatientPlus articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use, so you may find the language more technical than the condition leaflets.

There are a number of organisations involved in liaison between patients, the public and the National Health Service (NHS). They have one or more of the following roles:

  • Representing the views of patients and the public to the NHS.
  • Monitoring how well NHS bodies perform in taking account of these views.
  • Supporting patients who are having difficulty with NHS services; for example, in finding a service or in making a complaint.

This article outlines the various bodies involved in these roles. There have been various changes over the period of a decade. The more recent developments are explained.

Community Health Councils (CHCs) were established by Act of Parliament in 1974 to monitor and review the NHS and to recommend improvements. They also had a role in supporting and helping patients with their local health services.

CHCs were abolished in England in 2003, but continue in Wales. The concept of public and patient involvement in healthcare is still pursued. Each country has various organisations (below) to assist in this field.

New legislation came into force in April 2010 regarding the NHS duty to report on consultations. This requires all Clinical Commissioning Groups (CCGs) and strategic health authorities that commission services to explain how they have acted upon feedback from patients and the public. This has been termed 'Real Accountability'.

The overall structure and organisation of the NHS in England is detailed on the NHS choices website.[2]

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The Care Quality Commission (CQC)[3][4]

This is the independent regulator of all health and adult social care in England.

Changes dating from April 2010 are:

  • All NHS trusts in England must register with the CQC.
  • Trusts will be visited by inspectors at least once every two years to scrutinise standards
  • The CQC has the power to fine, prosecute or close down trusts which fail to meet standards.
  • For some trusts, registration under the new system is conditional on improvements being made in areas such as infection control and use of unregistered nursing agencies.

The new regulations are more stringent than the previous CQC setup, in which hospitals completed self-assessments and only around 20% of hospitals were inspected each year.

NHS GP practices and primary care providers must also register with the CQC:

  • From April 2012, primary care providers must be registered with the CQC if they provide only NHS primary medical services contracted by a primary care trust, or if NHS primary medical services are their main purpose.
  • This includes NHS GP practices, walk-in centres, out-of-hours services and contracts with the Secretary of State.
  • GP practices that are part of a co-operative or federation will need to register (in addition to registration of the co-operative or federation).
  • Key principles include placing the views of service users at the centre of the system.

Monitor[5] 

The role of Monitor is to protect and promote the interests of patients by ensuring that the whole sector works for their benefit. Monitor ensures that:

  • Public sector providers are well led so that they can provide high-quality care to local communities.
  • Essential NHS services continue if a provider gets into difficulty.
  • The NHS payment system rewards quality and efficiency.
  • Choice and competition operate in the best interests of patients.

Healthwatch England[6] 

Healthwatch is the new independent consumer champion that gathers and represents the public's views on health and social care services in England.

Healthwatch England is the national consumer champion in health and care. Healthwatch has significant statutory powers to ensure the voice of the consumer is strengthened and heard by those who commission, deliver and regulate health and care services.

The Health and Social Care Act formalises the relationship between Healthwatch England, the Secretary of State, NHS England, Care Quality Commission, Monitor and English local authorities.

NHS Complaints Advocacy[7] 

NHS Complaints Advocacy helps patients to make a complaint about their NHS care or treatment in many areas in England. NHS Complaints Advocacy is free, confidential and independent of the NHS.

The Patient Client Council (PCC) has replaced the four Health and Social Services Councils from April 2009. It is a regional body with five local offices.

Role of the PCC:

  • To represent the interests of the public by their views on services.
  • To engage with Health and Social Care (HSC) organisations to ensure that the needs of the public are addressed by HSC services.
  • To promote the involvement of patients and the public in the planning and delivery of HSC.
  • To assist individuals in making complaints regarding their healthcare or social care.
  • To promote advice and information to the public concerning HSC.

The Scottish Executive Health Department (SEHD) manages the 14 health boards in Scotland. Each covers a defined geographical area and is responsible for NHS services in that area. SEHD also manages the other health services (eight special health boards) covering services such as NHS 24 and the ambulance service.

Scottish Health Council[9]

This was launched by the Scottish Executive in April 2005 to promote patient-centred care and public involvement in NHS services.[10]

  • It is part of NHS Quality Improvement Scotland (NHS QIS) - below.
  • Its role is to ensure that patients' and public views be considered by the health boards, and it can comment on how well the boards perform in this respect.
  • The Council has a local office in each Health Board area. Each local office has a Local Advisory Council, made up of volunteers.

NHS Quality Improvement Scotland[11]

NHS QIS is a special health board working with health services in Scotland to improve care. One of its aims is to be 'engaged with patients, carers and the general public'.

The 'Patient Experiences' projects aim to co-ordinate patients' experiences of the NHS. Patient feedback can then be used to promote improvement in services.

There are seven health boards. They are allocated resources on the basis of their population. They provide all healthcare, in partnership with local government. There are three All Wales trusts, responsible for the ambulance service, cancer services, and public health.

Community Health Councils (CHCs)[12]

From April 2010, there are eight CHCs in Wales. This is a reduction from the 20 CHCs formerly. The new CHCs are named according to their respective Local Health Board.

CHCs are concerned with all aspects of the Health Service and can give advice to the public. Each Council has the statutory power to visit hospitals, GP surgeries and care homes. Their work may include:

  • Involvement and consultation - eg, with local groups.
  • Representing local interests - eg, proposing improvements or challenging plans for change.
  • Research and information - eg, surveys of local need.
  • Advice for patients - eg, information about local NHS services, and patients' rights.

CHC members are volunteers drawn from local authority nominations and from the voluntary sector. The CHC may co-opt additional members locally if needed.

Healthcare Inspectorate Wales (HIW)[13]

  • HIW is responsible for providing independent assurance about the quality and safety of NHS and independent healthcare organisations in Wales.
  • HIW may also carry out special reviews where there are systematic failures in healthcare services.

Further reading & references

  1. NHS England
  2. The NHS in England; NHS Choices
  3. No authors listed; Improving quality of care in the NHS. Lancet. 2010 Apr 3;375(9721):1136.
  4. Care Quality Commission
  5. Monitor
  6. Healthwatch England
  7. NHS Complaints Advocacy; POhWER
  8. Patient and Client Council
  9. Scottish Health Council
  10. Scottish Government Health and Social Care Directorates
  11. Healthcare Improvement Scotland
  12. Board of Community Health Councils in Wales; Health in Wales
  13. Healthcare Inspectorate Wales

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. EMIS has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.

Original Author:
Dr Naomi Hartree
Current Version:
Peer Reviewer:
Dr John Cox
Last Checked:
13/01/2014
Document ID:
1393 (v23)
© EMIS