Important role in this process belongs to the well thought-out structure of the UK health system, the heart of which is the Department of Health, which creates and centrally controls the implementation of laws and regulations in the healthcare industry; the major decisions at the local level are made by local NHS units. There is also a third type of governmental body, which serves as a link between the above two levels of the organization of health, – Strategic Health Authorities. For example, today there are 28 such structures responsible for specific regions which ensure the integration of national development priorities (such as programs for early detection of cancer) in the plans of local medical institutions (Allen 2009 pp. 373-389).
Depending on the scope all the trusts of health system (acute trusts, care trusts, mental health trusts, ambulance trusts) are subdivided into several groups, the main of which are the primary care trusts involved in providing primary health care and public health. In late 2006, the number of these organizations was reduced from 303 to 152, which, on the government plans, should improve management efficiency and reduce costs (Taylor-Gooby 2008 pp. 288-306).
It is also noteworthy that the Department of Health provides primary care trusts the right to use the tactics of outsourcing, i.e. use the services of private medical institutions for a more rational allocation of resources (Harrington 2009 pp. 376-399). This approach is very efficient in cases when the required interventions are urgent and all available public facilities for some reasons have no opportunities to perform them. Some medical centers conducting prearranged outpatient surgery and diagnostic procedures in areas where waiting lists are very long, for example in ophthalmology, are also privately owned.
Independent trusts also have greater access to investment funds for both public and private sector (Harrington 2009 pp. 376-399). On the other hand, since the NHS no longer so closely monitors the efficiency of the system, there is a need to establish a monitoring committee, which usually consists of representatives from local authorities, whose work is controlled by an independent agency (Anscombe 2008 pp. 222-224).
Monitoring of the implementation of all necessary recommendations is conducted by the Commission on Health.
According to the rankings, the analysis of the ability of trusts to the autonomous operation is performed, i.e. ability to acquire independent status (Williams 2010 pp. 213-14). All NHS organizations in the official rankings are evaluated on a scale from zero to three stars depending on the following indicators: waiting times and waiting lists, the number of terminations of interventions, hospital cleanliness, lethality, financial situation, the number of repeated requests to the ambulance service (Konteh 2008 pp.200-207)
Also, the Ministry of Health of Great Britain declared the new policy, corresponding to the new European legislation on the rights of patients, the policy of partnership between governments, patients and health care in order to provide the highest quality care wherever possible. It is recognized that every citizen needs the real and accessible information about the quality, effectiveness and results provided by the state medical assistance (Anscombe 2008 pp. 222-224). To monitor the quality of health care, there are15 common clinical indicators that, depending on their values, show the quality of work of any stationary and, consequently, health care in general (Currie 2009 pp. 267-284):
– Death in hospital within 30 days after the emergency and planned hospital admissions;
– Emergency re-admission within 28 days after discharge;
– The frequency of wound infections in hospital following surgical treatment of planned or emergency patients;
– Check back within 56 days after emergency admission with stroke
– Repeated surgery after surgery suturing hernias;
– Death in hospital within 30 days after emergency admission with a heart attack;
– Damage to organs during surgical interventions at emergency and planned hospitalization;
– Lung thrombembolia in hospital after surgery of planned and emergency patients;
– Cardiac complications in patients of surgical hospitals operated on planned and emergency basis;
– The complications of the central nervous system after surgical procedures carried out on planned and emergency basis;
– Repeated surgery after surgery of prostate gland;
– Check back within 56 days at planned and emergency hospitalization for cervical hip fracture;
– Death in hospital within 30 days after the planned or emergency hospitalization for cervical hip fracture;
– Frequency of operations of uterine curettage among women under 40 years;
– Complications of drug therapy in patients of hospitals enrolled on a planned and emergency basis.
Collecting and managing information about the undesirable consequences of treatment can improve safety standards in NHS institutions. These functions are performed by the National Agency on the safety of patients, which distributes the information among the staff about the need to submit reports on the adverse effects of treatment and other hazardous events to patients, to improve the quality of modern health care.