Since the NHS is largely funded by our taxes, let’s start with the government: they decide how much money the NHS receives, and do top-level priority setting. The Secretary of State for Health is in charge of the Department of Health, which is actually quite slimmed down compared to what it used to be, and it passes most of its money on to a range of other organisations.
The lion’s share goes to an organisation called NHS England. It was created in 2013 as part of sweeping reforms aimed at improving services by increasing competition, cutting red tape and keeping the government out of the day-to-day running of the NHS. But this is all actually quite far from what’s really happening.
NHS England is responsible for overseeing the commissioning, the planning and the buying, of NHS services. In practice it also sets quite a lot of NHS strategy and behaves like an NHS headquarters. NHS England commissions some services itself, but passes most of its money onto 200 or so clinical commissioning groups across England, also known as CCGs, which identify local health needs and then plan and buy care for people in their area.