Framework agreement between the Department of Health and NHS England

The first framework defining the relationship between the Department of Health and NHS England was published in February 2014. The framework agreement set out how the Department of Health and NHS England would work in partnership and how both organisations would discharge their accountability responsibilities effectively.

The document explained that the Secretary of State for Health was ultimately accountable to Parliament for the NHS. As such, he or she would be responsible for setting the strategic direction of the health services; determining budget allocations across the health and care system; setting objectives for NHS England; and accounting to Parliament for the performance of the NHS.

The document explained that the government would publish a mandate (incorporating the NHS outcomes framework) at the start of the financial year, which would set out the objectives for NHS England, as well as its financial allocation. In response, NHS England would publish its annual business plan, setting out how it would meet its legal obligations and objectives.

The framework made clear that NHS England was responsible for the delivery of its objectives and the circumstances in which the Department of Health could intervene were very limited. Likewise, NHS England's interventions in clinical commissioning group (CCG) activities were limited, but it would be able to issue directions, remove some functions (and exercise them or ask another CCG to perform them), alter a CCG's constitution or dissolve a CCG.