Nottingham is a city and unitary authority area in Nottinghamshire, England, 128 miles north of London, 45 miles northeast of Birmingham and 56 miles southeast of Manchester, in the East Midlands. Nottingham has links to the legend of Robin Hood and to the lace-making and tobacco industries, it was granted its city charter in 1897 as part of Queen Victoria's Diamond Jubilee celebrations. Nottingham is a tourist destination. In 2017, Nottingham had an estimated population of 329,200; the population of the city proper, compared to its regional counterparts, has been attributed to its historical and tightly-drawn city boundaries. The wider conurbation, which includes many of the city's suburbs, has a population of 768,638, it is the second-largest in The Midlands. Its Functional Urban Area the largest in the East Midlands, has a population of 912,482; the population of the Nottingham/Derby metropolitan area is estimated to be 1,610,000. Its metropolitan economy is the seventh largest in the United Kingdom with a GDP of $50.9bn.
The city was the first in the East Midlands to be ranked as a sufficiency-level world city by the Globalization and World Cities Research Network. Nottingham has an award-winning public transport system, including the largest publicly owned bus network in England and is served by Nottingham railway station and the modern Nottingham Express Transit tram system, it is a major sporting centre, in October 2015 was named'Home of English Sport'. The National Ice Centre, Holme Pierrepont National Watersports Centre, Trent Bridge international cricket ground are all based in or around the city, the home of two professional league football teams; the city has professional rugby, ice hockey and cricket teams, the Aegon Nottingham Open, an international tennis tournament on the ATP and WTA tours. This accolade came just over a year. On 11 December 2015, Nottingham was named a "City of Literature" by UNESCO, joining Dublin, Edinburgh and Prague as one of only a handful in the world; the title reflects Nottingham's literary heritage, with Lord Byron, D. H. Lawrence and Alan Sillitoe having links to the city, as well as a contemporary literary community, a publishing industry and a poetry scene.
The city has two universities—Nottingham Trent University and the University of Nottingham—both of which are spread over several campuses in the city, with a total university student population of over 61,000. The city predates Anglo-Saxon times and was known in Brythonic as Tigguo Cobauc, meaning Place of Caves. In modern Welsh it is known poetically as Y Ty Ogofog and Irish as Na Tithe Uaimh "The Cavey Dwelling"; when it fell under the rule of a Saxon chieftain named Snot it became known as "Snotingaham". Some authors derive "Nottingham" from Snottenga and ham, but "this has nothing to do with the English form". Nottingham Castle was constructed in 1068 on a sandstone outcrop by the River Leen; the Anglo-Saxon settlement was confined to the area today known as the Lace Market and was surrounded by a substantial defensive ditch and rampart, which fell out of use following the Norman Conquest and was filled by the time of the Domesday Survey. Following the Norman Conquest the Saxon settlement developed into the English Borough of Nottingham and housed a Town Hall and Law Courts.
A settlement developed around the castle on the hill opposite and was the French borough supporting the Normans in the castle. The space between was built on as the town grew and the Old Market Square became the focus of Nottingham several centuries later. Defences, consisted of a ditch and bank in the early 12th century; the ditch was widened, in the mid-13th century, a stone wall built around much of the perimeter of the town. A short length of the wall survives, is visible at the northern end of Maid Marian Way, is protected as a Scheduled Monument. On the return of Richard the Lionheart from the Crusades, the castle was occupied by supporters of Prince John, including the Sheriff of Nottingham, it was besieged by Richard and, after a sharp conflict, was captured. In the legends of Robin Hood, Nottingham Castle is the scene of the final showdown between the Sheriff and the hero outlaw. By the 15th century Nottingham had established itself as a centre of a thriving export trade in religious sculpture made from Nottingham alabaster.
The town became a county corporate in 1449 giving it effective self-government, in the words of the charter, "for eternity". The Castle and Shire Hall were expressly excluded and remained as detached Parishes of Nottinghamshire. One of those impressed by Nottingham in the late 18th century was the German traveller C. P. Moritz, who wrote in 1782, "Of all the towns I have seen outside London, Nottingham is the loveliest and neatest. Everything had a modern look, a large space in the centre was hardly less handsome than a London square. A charming footpath leads over the fields to the highway. … Nottingham … with its high houses, red roofs and church steeples, looks excellent from a distance."During the Industrial Revolution, much of Nottingham's prosperity was founded on the textile industry.
East of England Ambulance Service
The East of England Ambulance Service NHS Trust is the authority responsible for providing National Health Service ambulance services in the counties of Bedfordshire, Essex, Hertfordshire and Suffolk, in the East of England region. These consist of 7,500 square miles, it is one of 10 Ambulance Trusts providing England with emergency medical services, is part of the NHS, receiving direct government funding for its role. There is no charge to patients for use of the service, under the Patient's Charter every person in the United Kingdom has the right to the attendance of an ambulance in an emergency; as well as providing an emergency ambulance service, the Trust provides non emergency patient transport services, commercial services and special operations such as emergency planning, hazardous materials incident response. The service support a number of emergency charities, such as air ambulances, who provide doctors for serious incidents; the Trust controls the mobilisation of critical care charities throughout its area.
These include Magpas, Essex & Herts Air Ambulance, East Anglian Air Ambulance, BASICS Essex Accident Rescue Service, SARS, NARS and BASICS Hertfordshire. The service can if required, mobilise London's Air Ambulance and the Kent and Sussex Air Ambulance if there is a major incident requiring more than one critical care team, where other teams in the region are operating at maximum capacity; the trauma teams are dispatched by a Critical Care Paramedic at the Critical Care Desk, in their Control Room in Chelmsford, who filters through every call the ambulance service receives and makes a clinical decision on whether to dispatch a critical care resource. The trust was formed on 1 July 2006 following the three-way merger of the Bedfordshire and Hertfordshire Ambulance Service NHS Trust, the East Anglian Ambulance NHS Trust and the Essex Ambulance Service NHS Trust; the result was a service covering an area of over 7,500 square miles with a population of 5.8 million people, one which answers more than one million emergency calls per year.
The East Anglian Ambulance NHS Trust had been formed in 1994 from the three-way merger of Cambridgeshire and Suffolk Ambulance Services. In 2009, the Trust was censured by the Care Quality Commission after inspection of an ambulance depot and seven of its 100 ambulance stations found patient-carrying vehicles were "dirty" and that staff were "unsure of basic measures for infection prevention and control"; the service launched an "urgent and comprehensive review" of its ambulance cleaning programme and reiterated its stance on patient safety, adding that "ensuring consistent high standards of cleanliness is a challenge" with so many stations, covering six counties and an area of 7,500 square-miles. In 2015/16, the trust received 1,037,119 emergency calls and handled 500,620 non-emergency patient transport journeys; the trust arrived at 73.6% of emergency Red 1 calls within eight minutes, 69.4% of emergency Red 2 calls within eight minutes. EEAST has around 1,500 volunteers; as of July 2016, the Trust has the following resources in operation: 357 front-line emergency ambulances 201 marked rapid-response vehicles 164 non-emergency ambulances 52 major incident support vehicles Over 130 ambulance stations and response posts 3 emergency operations centers in Bedford and NorwichThe Trust has its own emergency driving school, which trains drivers in 999 emergency driving under blue lights and sirens.
The Trust used the Mercedes Sprinter as front-line Double Staffed Ambulances, with the exception of a single Vauxhall Movano 4 wheel drive vehicle for use at Newmarket Racecourse. In 2009, the service started the transition to a brand-new Sprinter only fleet from a wide range of other brands - including Fords and older Mercedes vehicles; the scheme was finished in 2016, when the last brand-new Sprinter was delivered, although many of the older ones are now ending their cycle life. In March 2018, four new vehicles will be trialled across the East of England, with one concept vehicle being designed for and by the Trust. In May 2018 the trust bought 32 five-year-old vehicles decommissioned by the West Midlands Ambulance Service - described as "clapped out vehicles which colleagues in other trusts would have sent to the scrapyard" and contrasted with the luxury cars with which senior managers were provided in 2017. Ford Mondeos and Skoda Octavia Scouts are the most common amongst the fleet. In addition Land Rover Freelander and Land Rover Discovery Sport operate out of a limited number of bases.
Some Land Rover are used as Officer Cars. Renault Masters and Vauxhall Movanos are used for the Patient Transport Service. A number of these vehicles are fitted with blue sirens for High Dependency transfers; the Hazardous Area Response Team team uses Volkswagen Transporters and Mercedes Sprinters, all of which have 4x4 capability. The new fleet arrived in 2017, standardising these vehicles across the 10 ambulances services in England and Wales, it replaced Iveco Dailys. The trust provides Critical Care Paramedics to 3 local charity air ambulances in the region: Magpas, Essex & Herts Air Ambulance and the East Anglian Air Ambulance; these paramedics work alongside doctors to administer advanced treatment at the scene of the accident. Although the service uses the air ambulances, it does not fund the charit
BBC News is an operational business division of the British Broadcasting Corporation responsible for the gathering and broadcasting of news and current affairs. The department is the world's largest broadcast news organisation and generates about 120 hours of radio and television output each day, as well as online news coverage; the service maintains 50 foreign news bureaus with more than 250 correspondents around the world. Fran Unsworth has been Director of News and Current Affairs since January 2018; the department's annual budget is in excess of £350 million. BBC News' domestic and online news divisions are housed within the largest live newsroom in Europe, in Broadcasting House in central London. Parliamentary coverage is broadcast from studios in Millbank in London. Through the BBC English Regions, the BBC has regional centres across England, as well as national news centres in Northern Ireland and Wales. All nations and English regions produce their own local news programmes and other current affairs and sport programmes.
The BBC is a quasi-autonomous corporation authorised by Royal Charter, making it operationally independent of the government, who have no power to appoint or dismiss its director-general, required to report impartially. As with all major media outlets it has been accused of political bias from across the political spectrum, both within the UK and abroad; the British Broadcasting Company broadcast its first radio bulletin from radio station.2LO In 14 November 1922. Wishing to avoid competition, newspaper publishers persuaded the government to ban the BBC from broadcasting news before 7:00 pm, to force it to use wire service copy instead of reporting on its own. On Easter weekend in 1930, this reliance on newspaper wire services left the radio news service with no information to report after saying There is no news today. Piano music was played instead; the BBC gained the right to edit the copy and, in 1934, created its own news operation. However, it could not broadcast news before 6 PM until World War II.
Gaumont British and Movietone cinema newsreels had been broadcast on the TV service since 1936, with the BBC producing its own equivalent Television Newsreel programme from January 1948. A weekly Children's Newsreel was inaugurated on 23 April 1950, to around 350,000 receivers; the network began simulcasting its radio news on television in 1946, with a still picture of Big Ben. Televised bulletins began on 5 July 1954, broadcast from leased studios within Alexandra Palace in London; the public's interest in television and live events was stimulated by Elizabeth II's coronation in 1953. It is estimated that up to 27 million people viewed the programme in the UK, overtaking radio's audience of 12 million for the first time; those live pictures were fed from 21 cameras in central London to Alexandra Palace for transmission, on to other UK transmitters opened in time for the event. That year, there were around two million TV Licences held in the UK, rising to over three million the following year, four and a half million by 1955.
Television news, although physically separate from its radio counterpart, was still under radio news' control – correspondents provided reports for both outlets–and that first bulletin, shown on 5 July 1954 on the BBC television service and presented by Richard Baker, involved his providing narration off-screen while stills were shown. This was followed by the customary Television Newsreel with a recorded commentary by John Snagge, it was revealed that this had been due to producers fearing a newsreader with visible facial movements would distract the viewer from the story. On-screen newsreaders were introduced a year in 1955 – Kenneth Kendall, Robert Dougall, Richard Baker–three weeks before ITN's launch on 21 September 1955. Mainstream television production had started to move out of Alexandra Palace in 1950 to larger premises – at Lime Grove Studios in Shepherd's Bush, west London – taking Current Affairs with it, it was from here that the first Panorama, a new documentary programme, was transmitted on 11 November 1953, with Richard Dimbleby becoming anchor in 1955.
On 18 February 1957, the topical early-evening programme Tonight, hosted by Cliff Michelmore and designed to fill the airtime provided by the abolition of the Toddlers' Truce, was broadcast from Marconi's Viking Studio in St Mary Abbott's Place, Kensington – with the programme moving into a Lime Grove studio in 1960, where it maintained its production office. On 28 October 1957, the Today programme, a morning radio programme, was launched in central London on the Home Service. In 1958, Hugh Carleton Greene became head of Current Affairs, he set up a BBC study group whose findings, published in 1959, were critical of what the television news operation had become under his predecessor, Tahu Hole. The report proposed that the head of television news should take control, that the television service should have a proper newsroom of its own, with an editor-of-the-day. On 1 January 1960, Greene became Director-General and brought about big changes at BBC Television and BBC Television News. BBC Television News had been created in 1955, in response to the founding of ITN.
The changes made by Greene were aimed at making BBC reporting more similar to ITN, rated by study groups held by Greene. A newsroom was created at Alexandra Palace, television reporters were recruited and given the opportunity to write and voice their own scripts–without the "impossible burden" of having to cover stories for radio too. In 1987 thirty years John B
Northern Ireland Ambulance Service
The Northern Ireland Ambulance Service Health and Social Care Trust is an ambulance service that serves the whole of Northern Ireland. As with other ambulance services in the United Kingdom, it does not charge its patients directly for its services, but instead receives funding through general taxation, it responds to medical emergencies in Northern Ireland with the 300-plus ambulance vehicles at its disposal. Its fleet includes mini-buses, ambulance officers' cars, support vehicles, RRVs and accident and emergency ambulances; the Northern Ireland Ambulance Service was formed on 1 April 1995 through the amalgamation of its 4 predecessors. Its full title is Social Care Trust; the Service employs 1,300 staff of which 420 are Paramedics, 300 are EMTs and 100 are Control staff, which work shift patterns to ensure the service is operational 24/7. They are based across 46 stations & sub-stations, 2 Control Centres and a Regional Ambulance Training Centre, it responds to 201,000 emergency calls per year with a combination of traditional emergency ambulances with two crew members, rapid response vehicles crewed by a single paramedic.
RRV's respond to calls where there is a potential immediate life-threat because they can respond more than a conventional ambulance. Double-crew ambulances respond to both Emergency and Non-emergency calls as well as providing critical-care transfers between hospitals; the Trust aims to provide at least one Paramedic to every emergency call by staffing each double-crew, emergency ambulance with two Paramedics or a Paramedic and an Emergency Medical Technician and utilising Rapid Response Vehicles. The Trust has not adopted the controversial use of ECA's in the way many other UK Ambulance Services have. In Northern Ireland there is no training programme in any Northern Ireland Universities to train Paramedics. In addition to the emergency service, NIAS has a fleet of Patient Care Service vehicles which are used for more routine patient transport to/from hospital. Within the Patient Care Service there are both single-crewed'sitting case' vehicles as well as double-crewed'intermediate care vehicles' which carry a stretcher.
In 2016 NIAS was commissioned to provide a Helicopter Emergency Medical Service for the first time in Northern Ireland, by the only region of the UK not to have one. Following a public consultation, they partnered with the charity Air Ambulance Northern Ireland who provide the aircraft and airbase, with the doctors and paramedics provided by NIAS; the service undertook its first live mission in August 2017. NIAS has a target time of 8 minutes to reach the scene of an emergency although, during December 2017 only 47.5% of this target was met therefore the average response time in Northern Ireland was 16 minutes 10 seconds. The trust works with volunteer and private ambulance services to help cope and meet key response times, this is due to the current increased demand and squeeze on public spending across Northern Ireland Staff have expressed concern by the growing pressures they face and overall low moral across the service; the ambulance service aims to restructure the service to cope with future increased demand.
In September 2018 the ambulance service ask the Department of Health for an additional £30 million to restructure and to recruit an additional 300 staff of which include Paramedics, EMT's and Emergency call takers. The recruitment is hoped to increase response times, relieve pressure on staff and get to the sickest quickest. Emergency medical services in the United Kingdom National Health Service List of Government departments and agencies in Northern Ireland HSE National Ambulance Service – Ambulance service in the Republic of Ireland Official website
An emergency is a situation that poses an immediate risk to health, property, or environment. Most emergencies require urgent intervention to prevent a worsening of the situation, although in some situations, mitigation may not be possible and agencies may only be able to offer palliative care for the aftermath. While some emergencies are self-evident, many smaller incidents require that an observer decide whether it qualifies as an emergency; the precise definition of an emergency, the agencies involved and the procedures used, vary by jurisdiction, this is set by the government, whose agencies are responsible for emergency planning and management. An incident, to be an emergency, conforms to one or more of the following: if it: Poses an immediate threat to life, property, or environment Has caused loss of life, health detriments, property damage, or environmental damage has a high probability of escalating to cause immediate danger to life, property, or environmentIn the United States, most states mandate that a notice be printed in each telephone book that requires that someone must relinquish use of a phone line, if a person requests the use of a telephone line to report an emergency.
State statutes define an emergency as, "...a condition where life, health, or property is in jeopardy, the prompt summoning of aid is essential."Whilst most emergency services agree on protecting human health and property, the environmental impacts are not considered sufficiently important by some agencies. This extends to areas such as animal welfare, where some emergency organizations cover this element through the "property" definition, where animals owned by a person are threatened; this means that some agencies do not mount an "emergency" response where it endangers wild animals or environment, though others respond to such incidents. The attitude of the agencies involved is to reflect the predominant opinion of the government of the area. Many emergencies cause an immediate danger to the life of people involved; this can range from emergencies affecting a single person, such as the entire range of medical emergencies including heart attacks, cardiac arrest and trauma, to incidents that affect large numbers of people such as natural disasters including tornadoes, floods, earthquakes and outbreaks of diseases such as cholera and malaria.
Most agencies consider these the highest priority emergency, which follows the general school of thought that nothing is more important than human life. Some emergencies are not immediately threatening to life, but might have serious implications for the continued health and well-being of a person or persons; the causes of a health emergency are very similar to the causes of an emergency threatening to life, which includes medical emergencies and natural disasters, although the range of incidents that can be categorized here is far greater than those that cause a danger to life. Many life emergencies, such as cardiac arrest, are health emergencies; some emergencies do not endanger life, health or property, but do affect the natural environment and creatures living within it. Not all agencies consider this a genuine emergency, but it can have far-reaching effects on animals and the long term condition of the land. Examples would include forest fires and marine oil spills. Agencies across the world have different systems for classifying incidents, but all of them serve to help them allocate finite resource, by prioritising between different emergencies.
The first stage of any classification is to define whether the incident qualifies as an emergency, if it warrants an emergency response. Some agencies may still respond to non-emergency calls, depending on their remit and availability of resource. An example of this would be a fire department responding to help retrieve a cat from a tree, where no life, health or property is at risk. Following this, many agencies assign a sub-classification to the emergency, prioritising incidents that have the most potential for risk to life, health or property. For instance, many ambulance services use a system called the Advanced Medical Priority Dispatch System or a similar solution; the AMPDS categorises all calls to the ambulance service using it as either'A' category,'B' Category or'C' category. Some services have a fourth category, where they believe that no response is required after clinical questions are asked. Another system for prioritizing medical calls is known as Emergency Medical Dispatch. Jurisdictions that use EMD assign a code of "alpha", "bravo", "charlie", delta or "echo" to each inbound request for service.
Other systems use objective measures to direct resource. Two such systems are SAD CHALET and ETHANE, which are both mnemonics to help emergency services staff classify incidents, direct resource; each of these acronyms helps ascertain the number of ca
Nottinghamshire is a county in the East Midlands region of England, bordering South Yorkshire to the north-west, Lincolnshire to the east, Leicestershire to the south, Derbyshire to the west. The traditional county town is Nottingham, though the county council is based in West Bridgford in the borough of Rushcliffe, at a site facing Nottingham over the River Trent; the districts of Nottinghamshire are Ashfield, Broxtowe, Mansfield and Sherwood, Rushcliffe. The City of Nottingham was administratively part of Nottinghamshire between 1974 and 1988, but is now a unitary authority, remaining part of Nottinghamshire for ceremonial purposes. In 2017, the county was estimated to have a population of 785,800. Over half of the population of the county live in the Greater Nottingham conurbation; the conurbation has a population of about 650,000, though less than half live within the city boundaries. Nottinghamshire lies on the Roman Fosse Way, there are Roman settlements in the county; the county was settled by Angles around the 5th century, became part of the Kingdom, Earldom, of Mercia.
However, there is evidence of Saxon settlement at the Broxtowe Estate, near Nottingham, Tuxford, east of Sherwood Forest. The name first occurs in 1016, but until 1568, the county was administratively united with Derbyshire, under a single Sheriff. In Norman times, the county developed woollen industries. During the industrial revolution, the county held much needed minerals such as coal and iron ore, had constructed some of the first experimental waggonways in the world. In the 18th and 19th centuries, mechanised deeper collieries opened, mining became an important economic sector, though these declined after the 1984–85 miners' strike; until 1610, Nottinghamshire was divided into eight Wapentakes. Sometime between 1610 and 1719, they were reduced to six – Newark, Thurgarton, Rushcliffe and Bingham, some of these names still being used for the modern districts. Oswaldbeck was absorbed in Bassetlaw, of which it forms the North Clay division, Lythe in Thurgarton. Nottinghamshire is famous for its involvement with the legend of Robin Hood.
This is the reason for the numbers of tourists who visit places like Sherwood Forest, City of Nottingham, the surrounding villages in Sherwood Forest. To reinforce the Robin Hood connection, the University of Nottingham in 2010 has begun the Nottingham Caves Survey, with the goal "to increase the tourist potential of these sites"; the project "will use a 3D laser scanner to produce a three dimensional record of more than 450 sandstone caves around Nottingham". Nottinghamshire was mapped first by Christopher Saxton in 1576; the map was the earliest printed map at a sufficiently useful scale to provide basic information on village layout, the existence of landscape features such as roads, tollbars and mills. Nottinghamshire, like Derbyshire, South Yorkshire, sits on extensive coal measures, up to 900 metres thick, occurring in the north of the county. There is an oilfield near Eakring; these are overlaid by sandstones and limestones in the west, clay in the east. The north of the county is part of the Humberhead Levels lacustrine plain.
The centre and south west of the county, around Sherwood Forest, features undulating hills with ancient oak woodland. Principal rivers are the Trent, Idle and Soar; the Trent, fed by the Soar and Idle, composed of many streams from Sherwood Forest, run through wide and flat valleys, merging at Misterton. A point just north of Newtonwood Lane, on the boundary with Derbyshire is the highest point in Nottinghamshire; the lowest is Peat Carr, east of Blaxton, at sea level. Nottinghamshire is sheltered by the Pennines to the west, so receives low rainfall at 641 to 740 millimetres annually; the average temperature of the county is 8.8–10.1 degrees Celsius. The county receives between 1470 hours of sunshine per year. Nottinghamshire contains one green belt area, first drawn up from the 1950s. Encircling the Nottingham conurbation, it stretches for several miles into the surrounding districts, extends into Derbyshire. Nottinghamshire is represented by eleven members of parliament. Kenneth Clarke of Rushcliffe is a former Conservative Chancellor of the Exchequer and Lord High Chancellor.
Following the 2017 County Council elections, the County Council is controlled by a coalition of Conservatives and Mansfield Independent Forum, having taken control from the Labour administration. The seats held are 31 Conservatives, 23 Labour, 11 Independents, 1 Liberal Democrat. In the previous 2013 election, the County Council was Labour controlled, a gain from the Conservatives. Local government is devolved to seven local district councils. Ashfield, Bassetlaw and Mansfield
National Health Service (England)
The National Health Service is the publicly funded national healthcare system for England and one of the four National Health Services for each constituent country of the United Kingdom. It is the largest single-payer healthcare system in the world. Funded through the government funding and overseen by the Department of Health and Social Care, NHS England provides healthcare to all legal English residents, with most services free at the point of use; some services, such as emergency treatment and treatment of infectious diseases, are free for everyone, including visitors. Free healthcare at the point of use comes from the core principles at the founding of the National Health Service by the Labour government in 1948. In practice, "free at the point of use" means that anyone legitimately and registered with the system, available to legal UK residents regardless of nationality, can access the full breadth of critical and non-critical medical care, without payment except for some specific NHS services, for example eye tests, dental care and aspects of long-term care.
These charges are lower than equivalent services provided by a private provider and many are free to vulnerable or low-income patients. The NHS provides the majority of healthcare in England, including primary care, in-patient care, long-term healthcare and dentistry; the National Health Service Act 1946 came into effect on 5 July 1948. Private health care has continued parallel to the NHS, paid for by private insurance: it is used by about 8% of the population as an add-on to NHS services; the NHS is funded from general taxation, with a small amount being contributed by National Insurance payments and from fees levied in accordance with recent changes in the Immigration Act 2014. The UK government department responsible for the NHS is the Department of Health and Social Care, headed by the Secretary of State for Health and Social Care. On 9 January 2018, the Department of Health was renamed the Department of Social Care; the Department of Health had a £110 billion budget in 2013–14, most of this being spent on the NHS.
In 2017, UK media reported that the Care Quality Commission said that the NHS is "straining at the seams" with a "precarious" future. Sources do not always make clear; the NHS was established within the differing nations of the United Kingdom through differing legislation, such there has never been a singular British healthcare system, instead there are 4 health services in the United Kingdom. In 2009, NHS England agreed to a formal NHS constitution, which sets out the legal rights and responsibilities of the NHS, its staff, users of the service, makes additional non-binding pledges regarding many key aspects of its operations; the Health and Social Care Act 2012 came into effect in April 2013, giving GP-led groups responsibility for commissioning most local NHS services. Starting in April 2013, Primary Care Trusts began to be replaced by General Practitioner -led organisations called Clinical Commissioning Groups. Under the new system, a new NHS Commissioning Board, called NHS England, oversees the NHS from the Department of Health.
The Act has become associated with the perception of increased private provision of NHS services. In reality, the provision of NHS services by private companies long precedes this legislation, but there are concerns that the new role of the healthcare regulator could lead to increased use of private sector competition, balancing care options between private companies, NHS organisations. NHS Trusts responded to the Nicholson challenge—which involved making £20 billion in savings across the service by 2015; some NHS organisations use referral management centres to help reduce inappropriate referrals, in an attempt to save the NHS money. Millions of pounds have been spent for these services, 32% of which are provided by private companies, since 2013. Of the 211 clinical commissioning groups surveyed by the British Medical Journal in 2016, 184 responded and 72 of those said they had used such schemes. Of those CCGs using these services, 14% could show savings, 12% showed no overall savings and 74% could not show whether money had been saved.
Because these services can prevent GPs from referring patients to hospitals, there are some concerns they may delay diagnosis and compromise patient safety. GPs are leaving the profession because they feel the government undervalues them, they feel the government pushes too much work onto them. GPs who do all the work needed to ensure patient safety fear that overwork compromises their own health. There were 33,302 GPs in England in October 2017, 34,495 the previous year; the Care Quality Commission found patient safety is compromised in hospitals because staff are overworked and do not have time for safety checks and procedures. Staff shortages, high staff turnover and confusion over which NHS body is responsible for patient safety contribute to lapses in safety; the CQC stated: "Staff at both leadership and frontline levels told us that they felt overwhelmed by the volume and nature of the demands placed on them. The number of alerts and amount of other information from multiple organisations, for example about different targets and initiatives, can be unmanageable."
There are 2m patient safety incidents every year and 21,500 of them are serious. Problems have included swabs being left in a patient's bod