Information on Ambulance Trusts |
| There are currently 13 ambulance services covering England, which provide emergency access to health care. If you call for an emergency ambulance the calls are prioritised into three categories:
The control room decide what kind of response is needed and whether an ambulance is required. For all three types of emergency, they may send a rapid response vehicle, crewed by a paramedic, equipped to provide treatment at the scene of an accident. Over the last five years the number of ambulance 999 calls has gone up by a third. The NHS is also responsible for providing transport to get patients to hospital for treatment. In many areas it is the Ambulance Trust which provides this service. Strategic Health AuthoritiesCreated by the Government in 2002 to manage the local NHS on behalf of the Secretary of State, there were originally 28 Strategic Health Authorities ( SHA's ). On 1 July 2006, this number was reduced to 10. Fewer, more strategic organisations will deliver stronger commissioning functions, leading to improved services for patients and better value for money for the taxpayer. A map of the old and new SHAs is available from the Department of Health. Strategic Health Authorities are responsible for:
Strategic Health Authorities manage the NHS locally and are a key link between the Department of Health and the NHS. Care TrustsCare Trusts are organisations that work in both health and social care. They may carry out a range of services, including social care, mental health services or primary care services. Care Trusts are set up when the NHS and Local Authorities agree to work closely together, usually where it is felt that a closer relationship between health and social care is needed or would benefit local care services. At the moment there are only a small number of Care Trusts, though more will be set up in the future. Primary Care TrustsPrimary Care is the care provided by people you normally see when you first have a health problem. It might be a visit to a doctor or dentist, an optician for an eye test, or just a trip to a pharmacist to buy cough mixture. NHS Walk-in Centre's, and the phone line service NHS Direct, are also part of primary care. All of these services are managed for you by your local Primary Care Trust (PCT). Your PCT will work with local authorities and other agencies that provide health and social care locally to make sure that your local community's needs are being met. PCT's are now at the Centre of the NHS and will get 75% of the NHS budget. As they are local organisations, they are in the best position to understand the needs of their community, so they can make sure that the organisations providing health and social care services are working effectively. For example, your PCT must make sure there are enough services for people within their area and that these services are accessible. They must also make sure that all other health services are provided, including hospitals, dentists, opticians, mental health services, NHS Walk-In Centre's, NHS Direct, patient transport (including Accident & Emergency), population screening, and pharmacies. They are also responsible for getting health and social care systems working together to the benefit of patients. Mental Health TrustsMental Health Trusts provide health and social care services for people with mental health problems. Mental Health services can be provided through your GP, other primary care services, or through more specialist care. This might include counselling and other psychological therapies, community and family support, or general health screening. For example, people suffering bereavement, depression, stress or anxiety can get help from primary care or informal community support. If they need more involved support they can be referred for specialist care. More specialist care is normally provided by Mental Health Trusts or local council social services departments. Services range from psychological therapy, through to very specialist medical and training services for people with severe mental health problems. About two in every thousand people need specialist care for conditions such as severe anxiety problems or psychotic illness. Acute TrustsHospitals are managed by Acute Trusts, which make sure that hospitals provide high quality health care, and that they spend their money efficiently. They also decide on a strategy for how the hospital will develop, so that services improve. Acute Trusts employ a large part of the NHS workforce, including nurses, doctors, pharmacists, midwives and health visitors as well as people doing jobs related to medicine - physiotherapists, radiographers, podiatrists, speech and language therapists, counsellors, occupational therapists and psychologists. There are many other non-medical staff including receptionists, porters, cleaners, specialists in information technology, managers, engineers, caterers and domestic and security staff. Some Acute Trusts are regional or national Centre for more specialised care. Others are attached to universities and help to train health professionals. Acute Trusts can also provide services in the community, for example through health Centre, clinics or in people's homes. Foundation TrustsFoundation Trusts are a new type of NHS hospital run by local managers, staff and members of the public which are tailored to the needs of the local population. Foundation Trusts have been given much more financial and operational freedom than other NHS Trusts and have come to represent the Governments commitment to de-centralising the control of public services. These Trusts remain within the NHS and its performance inspection system. First introduced in April 2004, there are now 48 Foundation Trusts in England serving more than a quarter of the population. About the NHS - How the NHS WorksThe NHS was set up in 1948 and is now the largest organisation in Europe. It is recognised as one of the best health services in the world by the World Health Organisation but there need to be improvements to cope with the demands of the 21st century. The NHS is changing the way it works to make sure patients always come first. This has brought about some fundamental changes in the way the NHS is structured and the way in which the different organisations within the NHS relate to each other. The information and clickable diagram below shows you how the NHS structure works in England. For information on the health service in other parts of the UK, please visit the NHS in Northern Ireland , the NHS in Scotland or the NHS in Wales . The Isle of Man and the Channel Islands have separate independent health service structures. For more information please visit Isle of Man Government , States of Guernsey Government and States of Jersey Government . Patients
Safety Throughout all this change, patients need to know that the care they receive is safe as well as of a high standard. Staff too need to know they are working within a system which protects the patient and, where mistakes are made, they can report these to benefit others without the fear of being unduly blamed or punished.
Choice
But Choice is also about giving patients the power to drive up standards within the health service. Radical changes to the way hospitals are funded means hospitals are paid for the activity they actually undertake. It makes sense for hospitals, therefore, to ensure they are providing the sort of high-quality responsive services that will attract patients who have the power to choose. Information
Quality They are services delivered by the professionals with the most appropriate skills; they are tailored to each individual and include all the care that patient might need, not just part of it. So as well as treating patients for coronary heart disease, for instance, a quality service will offer a patient help to quit smoking and take more physical exercise. There have been some important developments in the last few years to ensure that NHS organisations and staff are properly rewarded for delivering high-quality patient care:
Primary care Primary Care Trusts (PCT's) Primary Care Trusts (PCT's) are now at the Centre of the NHS and control 80 per cent of the total NHS budget. Because they are local organisations, they are in the best position to understand the needs of their communities. PCT's are responsible for:
There are more than 300 PCT's covering all parts of England. They have been in place since April 2002 and report directly to their local Strategic Health Authority. As well as buying and monitoring services, they also play a crucial role in supporting NHS organisations. They help local GP practices, NHS Trusts and other parts of the NHS think more innovatively about how they deliver better, more convenient care to their local patient communities. More information about Primary Care Trusts. GP practices General practitioners (GP's) look after the health of people in their local community and deal with a wide range of health problems. They and their teams also provide health education and advice on things like smoking and diet, run clinics, give vaccinations and carry out simple surgical operations. New primary care contracts which govern the way GP's and practices are paid, are giving practice teams more freedom than ever before to develop services that best match the needs of their local populations. So, if there is a high incidence of heart disease, for instance, practices may choose to invest in a GP or nurse with specialist knowledge of that condition. Doctors usually work with a team including nurses, health visitors and midwives, as well as a range of other health professionals such as physiotherapists and occupational therapists. Practices are offering an increasingly wide range of services and treatments including tests to diagnose conditions like coronary heart failure and lung problems. But if a GP cannot deal with your problem themselves, they'll usually refer you to a hospital for tests, treatment or to see a consultant with specialised knowledge. Around 300 million consultations a year take place in England's practices. Every UK citizen has a right to be registered with a local GP and visits to the surgery are free. More information about GPs / Doctors. Dentists As a result of major changes to NHS dentistry (introduced in April 2006), Primary Care Trusts (PCT's) are now responsible for commissioning dental services - this covers routine care and specialised care services. Routine care refers to the work undertaken by dentists and their team (ie hygienists, therapists) in general practice - they undertake all the routine dental care and treatment necessary to maintain good oral health. This includes providing patients with treatments such as scaling and polishing, fillings, extractions, as well as fitting bridges and dentures and advice on how to look after teeth and gums in order to prevent oral health problems occurring. Dental practices may provide a mixture of NHS and private care - the NHS services your dentist provides depend on local oral health needs and the contract they have agreed with your PCT. For more specialised care such as surgery within the mouth, orthodontics (straightening teeth), domiciliary care (at home), sedation (easing anxiety) and more complicated root canal and bridge work, your dentist may refer you to another dentist either at a hospital or to another general dental practitioner who has an interest in this area. Contact your PCT to find out about the availability of general and specialised services within your local area. More information about Dentists . Pharmacists Pharmacists (sometimes called chemists) are experts in medicines and how they work. They play a key role in providing quality healthcare to patients. Working in the community, in primary care and within hospitals, pharmacists use their clinical expertise to ensure the safe supply and use of medicines. They dispense prescriptions and can advise on a range of ailments such as minor injuries, skin conditions and allergies. They can help you decide whether you need to see a doctor. You can talk to your pharmacists in confidence and you don't need to make an appointment. The Government is committed to making even better use of the skills of pharmacists to widen the range of quality care and advice available in convenient community settings. As part of this:
More information about Pharmacies . Opticians There are three kinds of opticians that provide eye services to the general public: Ophthalmic medical practitioners are qualified doctors who specialise in diseases and abnormalities of the eyes. They will test your sight, examine the health of your eyes, and give a prescription for spectacles, although they do not dispense them. Dispensing opticians are qualified to fit and supply spectacles to a prescription provided by an optometrist or ophthalmic medical practitioner. More information about Opticians. NHS Walk-in Centre's NHS Walk-in Centre's give you quick and easy access to health advice and treatment for minor illnesses and injuries. There are now 66 Walk-in Centre's throughout England, often situated near A&E and in convenient locations such as high streets and train stations. They are run by experienced NHS nurses and you don't need to make an appointment. Most are open seven days a week, from early in the morning until late in the evening, and offer a variety of services, such as:
More information about NHS Walk-in Centres. NHS Direct You can call NHS Direct on 0845 46 47 for confidential health advice and information 24-hours a day, 365 days a year. The lines are staffed by nurses and professional advisors. NHS Direct has become a trusted first point of contact for patients seeking medical help both inside and outside normal GP surgery hours. NHS Direct can offer you information on:
They can help you decide if you need to see a doctor and help reduce the worry of being ill or caring for someone else who is unwell. Calls to NHS Direct cost a maximum of 4 pence per minute from a BT landline. The cost of calls from mobiles and other networks may vary. Your service provider may charge a minimum cost per call. For patients' safety, calls to NHS Direct are recorded. NHS Direct Online , makes a wealth of health information and advice available through the Internet, including a detailed Self-help guide . The Website will also help you find your local GP, dental, pharmacy and optician services. The NHS Direct self-help guide is also available in the back of the Thomson Local directory. NHS Direct Interactive digital TV has also been launched to make health advice and information available through satellite television, by simply pressing the interactive button on your TV remote control. Emergency and urgent care
Increasingly, these services are working together in networks across whole communities and drawing in other care providers such as emergency social services and emergency mental health teams. This type of joined up working helps ensure that the most appropriate care is available to everyone across the community. More information about Accident & Emergency services . Secondary care Elective care means planned specialist medical care or surgery, usually following referral from a primary or community health professional such as a GP. Examples of elective care include a hip replacement operation or kidney dialysis. Elective care patients may be admitted either as an inpatient or a day case patient, or they may attend an outpatient consultation or clinic. Increasingly, patients are benefiting from quicker and more convenient elective care services through, for example:
Emergency care also known as Accident and Emergency (A&E) is when patients attend hospital as a result of an accident or trauma and require emergency treatment. Some patients will come to A&E themselves and others will arrive in an ambulance. Examples of emergency care include responses to a sudden onset of chest pain or a road traffic accident. Patients using A&E can now expect to be seen, treated and discharged - or admitted to a ward for further care - within four hours. They can also expect a better overall experience within A&E as a result of improved facilities such as designated areas for children. Other examples of secondary care services include specialist services for mental health, learning disability and older people. NHS Trusts Hospitals in the NHS are managed by NHS Trusts (sometimes called acute Trusts). These Trusts make sure that hospitals provide high quality health care, and that they spend their money efficiently. Their wide-ranging services are commissioned or purchased - on behalf of patients by Primary Care Trusts (PCT's) and include treatments where patients are admitted to hospital, day surgery which does not require an overnight hospital stay for the patient, as well as out-patient services where patients attend consultations and clinics. Increasingly, NHS Trusts are being commissioned by PCT's to provide services in the community closer to where people live. NHS Trusts employ most of the NHS workforce: consultants, doctors, nurses, hospital dentists, pharmacists, midwives and health visitors, managers and IT specialists, as well as people doing jobs related to medicine - physiotherapists, radiographers, podiatrists, speech and language therapists, dieticians, counsellors, occupational therapists and psychologists. There are many other support staff including receptionists, porters, cleaners, engineers, caterers and domestic and security staff who all make a key contribution to the overall experience of patients. Except in the case of emergencies, hospital treatment is arranged through a GP. This is called a referral. Appointments and treatment at NHS hospitals are free. NHS Foundation Trusts are a new type of NHS hospital run by local managers, staff and members of the public. Only the highest performing hospitals can apply to become NHS Foundation Trusts a status which gives them much more freedom in running their services than other NHS Trusts. The creation of Foundation Trusts clearly illustrates the shift of decision-making power to frontline-staff and the local communities they serve. However, Foundation Trusts remain firmly within the NHS and its framework of standards. More information about NHS Acute Trusts. Ambulance Trusts NHS Ambulance Trusts are the local organisations responsible for responding to 999 calls; transporting patients; and increasingly for providing out-of-hours care. If you call 999 for an emergency ambulance your call will be prioritised into one of three categories:
The control room at the ambulance trusts decides what kind of response you need and whether an ambulance is required. For all three types of call, they may send a rapid response vehicle, crewed by a paramedic and equipped to provide treatment at the scene of the emergency. Ambulance staff will assess the patient at the scene and decide whether the patient needs to go to hospital. If the patient does need to go to hospital, staff will treat and stabilise the patient so they can be transported. Ambulance crews are highly trained in all aspects of pre-hospital emergency care, ranging from road traffic injuries to cardiac arrest. Added to this, increasing numbers of paramedics are being trained in new skills, including the administration of clot-dissolving drugs to heart failure patients before they get to hospital a treatment which can greatly increase their chance of recovery. Patients who do not need to go to hospital may be treated at the scene and given advice on follow-up care, including referrals to other health professionals if necessary. Or for some Category C calls, patients may be offered over-the-phone advice or referred to their GP or NHS Walk-in Centre. Ambulance Trusts also provide a range of others services such as providing care outside of normal GP practice working hours; transporting patients to or from hospitals and day care services; and providing first aid More information about Ambulance Trusts. Care Trusts Care Trusts are one of the ways of bringing health and social care services closer together under a single organisational structure. This benefits patients who do not have to navigate their way round two systems to get the care they need. They carry out a range of services and are designed to provide more joined-up care for people whose needs are more complex. For instance, an older person suffering a fall may need urgent hospital treatment, followed by a period of intermediate care to get them back on their feet, and then longer-term support at home. Care Trusts aim to make the patient's journey' back to health as smooth as possible by coordinating a full care package which doesn't get stuck in the gaps between different organisations and different parts of the system. More information about Care Trusts. Mental Health Trusts About two in every thousand people need specialist care for conditions such as severe anxiety problems or psychotic illness. This level of care is normally provided by NHS Mental Health Trusts, working in partnership with local council social services departments. The services provided by Mental Health Trusts range from psychological therapy, through to very specialist care for people with severe mental health problems. Other, less complex and severe mental health problems can often be treated by your GP or other primary care services for example depression, stress or anxiety. Treatments might include counselling, psychological therapies, community and family support, or general health screening. With the right support and medication, many people are able to manage their mental illness themselves. More information about Mental Health Trusts. Strategic Health Authorities Strategic Health Authorities (SHA's) are responsible for managing and setting the strategic direction of the NHS locally. They support PCT's and other NHS organisations and make sure they are performing well. Specifically they:
There are 28 SHA's covering England and they are the key link between the NHS and the Department of Health. Now, with broad national targets set and monitored by the Healthcare Commission, and patient Choice providing an important indication of which NHS Trusts are performing most successfully, the performance management role of SHA's is set to diminish in the future. More information about Strategic Health Authorities. The Department of Health The aim of the Department of Health is to improve the health and well-being of people in England. It sets the standards and broad working practices of the NHS and local social services. The Department works on ways to prevent disease and help people live longer healthier lives. Specifically, the Department is responsible for:
More information about the Department of Health. The Information Centre for health and social care The Information Centre for health and social care (The IC) was created in April 2005 out of the former NHS Information Authority and the Department of Health statistics unit.
More information about The Information Centre. Key NHS partners
Social care providers A person coming out of hospital following a hip operation, for instance, may need a host of other care to ensure that they recover well in their own homes and maintain their independence. As well as ongoing health care delivered by the NHS, they may need help with dressing and washing or they may need special equipment such as grab rails and walking frames. These aspects of care would all be arranged by social services departments managed by Local Authorities. Stronger local partnerships between the NHS and social care are already helping ensure that older patients benefit from a single, thorough assessment of their needs, and have a tailored package of care that maximises their quality of life and independence. Find your local social care services. The independent sector is an important partner for the NHS and crucial in delivering faster, more convenient care and choice to NHS patients. The NHS is harnessing the extra capacity and innovation available in the independent sector in several ways, including the Independent Sector Treatment Centre Programme. This programme has already given hundreds of patients faster, streamlined access to care and greater choice in areas such as orthopaedics and opthalmology. Although the Centre's are run by independent companies, they must still offer the NHS value for money; meet the high clinical standards demanded by the NHS; and provide genuine extra capacity, rather than drawing doctors and nurses away from the NHS. The voluntary & community sector (VCS) is also a valuable partner in expanding NHS and social care services and improving the overall care patients receive. These organisations play a vital role in helping the NHS meet national standards in some of the highest priority areas such as care for cancer patients and older people; as well as in shaping services round the individual needs of patients. A recent formal agreement between the Department of Health, the NHS and the VCS will help ensure voluntary organisations play an even bigger role in delivering and improving local services in the future. How to Complain / ComplimentHow do I comment about my NHS treatment? NHS staff aim to give the best possible care to patients. But sometimes things do go wrong and the NHS Complaints Procedure was set up to use if you want to complain about the services or treatment you get from the NHS. You may, however, want to feedback positive comments on the care and services you have received. These comments are just as important as they tell NHS organisations what factors are contributing to a good experience for patients. In either case, a useful starting point is your Patient Advice and Liaison Service (PALS) at the NHS Trust or Primary Care Trust (PCT) where you received your NHS treatment. Your PALS officer will often be able to sort out the problem quickly and efficiently for you - but if they can't, they will give you useful advice about the NHS complaints procedure and the other avenues open to you to. Find the contact details for your Trust. NHS Complaints Procedure If you are unhappy with the treatment or service you have received from the NHS you are entitled to make a complaint, have it considered, and receive a response from the NHS organisation or primary care practitioner concerned. The NHS complaints procedure described below covers complaints made by a person about any matter connected with the provision of NHS services by NHS organisations or primary care practitioners in England (for instance doctors, dentists, opticians and pharmacists). The procedure also covers services provided overseas or by the independent sector where the NHS has paid for them. There may be different arrangements in place for the internal handling of complaints in Foundation Trusts (see below). Who can complain? Who can complain? What is the time limit for making a complaint? To whom should I complain initially? You can raise your concerns immediately by speaking to a member of staff (e.g. doctor, nurse, dentist, GP or practice manager). Another useful first step is to talk to the local Patient Advice and Liaison Service (PALS) which has been established in every NHS Trust and Primary Care Trust (PCT). PALS are not part of the complaints procedure itself, but they may be able to resolve your concerns quickly and informally, or if not, they will tell you more about the NHS complaints procedure and the Independent Complaints Advocacy Services - a free, independent and confidential service which can help you make a complaint about your local NHS. What if I'm still unhappy after local resolution? You should receive a response from a primary care practitioner within 10 working days or from the chief executive of the NHS organisation concerned within 20 working days. You should be kept informed of progress if this is not going to happen. NHS Foundation Trusts Independent Review Healthcare Commission Tel: 0845 601 3012 The Health Service Ombudsman Millbank Tower Tel: 0845 015 4033 Where can I get further advice and help?
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