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Who decideswho cares?Chris Mimnagh is a GP atWingate Medical Centre andCo-Director Clinical StrategyLiverpool Health Partners.28The NHS is ever changing – it’s nowonder we get confused. Whodecides what we need, who buysit? How is the money shared out?Kirkby GP Chris Mimnagh gives thelow down in simple terms.The NHS costs money to run, it alwayshas. In the past money was simply givenout by the government directly tohospitals and health service authorities.Now the purse strings are held bylocal Clinical Commissioning Groups, socalled because they commission – or buy- services for you and me.Organisations, like Mersey Care, whereyou go for your care, are called providers.This set up is good; it means controlof the money is closer to you and me.Because they are local, the commissioninggroups have a better idea of theirpopulation – whether there are moreyoung people older people, those withspecific needs – and they can buy theright services.Not to confuse you further but there’salso something called social care.Sometimes the money for your socialcare is held by you personally – not inyour purse or bank account, but putaway for you should you need it.You’d need to be assessed to seewhat you are entitled to.This sounds an ideal system to use inhealthcare, but it can’t happen simplybecause unlike social care, health careis often complex and specialised. Peoplemay need so many different services,from mental health services to diabetescare and knee replacements.In mental health services differentpeople may be paying the bills for yourcare. Some people need the complex orspecialist services such as those MerseyCare provides – eating disorders is aperfect example. These services will bebought by a commissioner who knowsa lot about them.