National Health Service (NHS) - History, NHS Policies and programmes, Structure, Criticism, Wikipedia project, Further reading
A system of health care established in the UK in 1948. World War 2 revealed the need for reform of the health and hospital services which had served up to that time. The new service was to be, and largely remains, a free service available to the whole population, without income limit, and funded out of general taxation. Existing municipal and voluntary hospitals were nationalized and came under the control of regional Health Boards (subsequently called Area Health Committees). Hospital consultants and specialists were salaried (full-time and part-time). General practitioners (GPs) remained self-employed, and received capitation fees based on the number of individuals who registered with them as patients. GPs are now organized into Primary Care Groups that serve defined geographical populations of around 100 000 people. They provide primary and community care for their patients, and purchase specialist care from hospital services. The NHS is supported by nurses, technical and scientific staff, and ancillary workers, and is the largest single employer of labour in the UK.
The National Health Service (NHS) is the "public face" of the four publicly funded health care systems of the United Kingdom. They were founded in 1948 and have become an integral part of British society, culture and everyday life: the NHS was once described by Nigel Lawson, former Chancellor of the Exchequer, as "the national religion". Private health care has continued parallel to the NHS, paid for largely by private insurance, but it is used only by a small percentage of the population, and generally as a top-up to NHS services.
NHS services are largely "free at the point of delivery", paid for by taxes; the NHS's budget for 2006–07 is £96 billion. Employing well over 1 million people, the NHS is the largest employer in Europe and one of the largest employers in the world, (believed to be third or fifth, according to different commentators).
The government department responsible for the NHS in England is the Department of Health, headed by the Secretary of State for Health, (presently Patricia Hewitt), who sits in the British Cabinet. Hewitt are:
Lord Warner (NHS Reform) Rosie Winterton (Health Services) Caroline Flint (Public Health) Andy Burnham (Delivery and Quality)The department also has one Parliamentary Under Secretary of State who is Ivan Lewis (Care Services).
The devolved administrations of Wales, Scotland and Northern Ireland are each responsible for their own NHS.
History
In the aftermath of World War II, Clement Attlee's Labour government created the NHS, based on the proposals of the Beveridge Report, prepared in 1942. The structure of the NHS in England and Wales was established by the National Health Service Act 1946 (1946 Act).
NHS Policies and programmes
Reforms under the Thatcher government
The 1980s saw the introduction of modern management processes (General Management) in the NHS to replace the previous system of consensus management. This recommended the appointment of general managers in the NHS with whom responsibility should lie. Financial pressures continued to place strain on the NHS. In 1987, an additional £101 million was provided by the government to the NHS. In 1988 the then Prime Minister, Margaret Thatcher, announced a review of the NHS.
In 1990, the National Health Service & opposition to what was claimed to be the Conservative intention to privatise the NHS became a major feature of Labour campaigning in the 1997 and subsequent British elections. Although the incoming government of Tony Blair (1997) stated its intention to remove the "internal market" and abolished fundholding, in effect the market was strengthened and fundholding reintroduced as part of Blair's ongoing reforms to modernise the NHS. (See NHS Wales and NHS Scotland for descriptions of their developments). Some new services have been developed to help manage demand, including NHS Direct.
The Blair Government, whilst leaving services free at point of use, has encouraged outsourcing of medical services and support to the private sector.
In 2005, surgicentres (ISTCs) treated around 3% of NHS patients (in England) having routine surgery. NHS Primary Care Trusts have been given the target of sourcing at least 15% of primary care from the private or voluntary sectors over the medium term.
Given ongoing redundancies within the NHS, accusations of staff cuts and "privatisation" are now made against the Blair government, often by NHS staff unions such as UNISON.
As a corollary to these intitiatives, the NHS has been required to take on pro-active socially "directive" policies, for example, in respect of smoking and obesity.
The NHS has also encountered significant problems with the IT innovations accompanying the Blair reforms. The NHS's National Programme for IT (NPfIT), believed to be the largest IT project in the world, is running significantly behind schedule and above budget, with friction between the Government and the programme contractors. The programme to computerise all NHS patient records is also experiencing great difficulties. Furthermore there are unresolved financial and managerial issues on training NHS staff to introduce and maintain these systems once they are operative.
Structure
Organisation
Responsibility for the National Health Services in Scotland, Wales and Northern Ireland belongs to the relevant devolved administration; the NHS for England is controlled by the UK government. Similar principles of service and management are common to all four services, and some NHS agencies (e.g. Links are provided to NHS Wales, NHS Scotland and Health and Care NI, the three sister organisations.
The NHS in England is managed at the top by the Department of Health, which takes political responsibility for the service. It controls Strategic Health Authorities (SHAs), which oversee all NHS operations in an area. There are 302 PCTs (these are also being reduced in number, by about half, to provide savings), which oversee England's 29,000 GPs and 18,000 NHS dentists. In addition, they commission acute services from other NHS Trusts and the private sector, provide directly primary care in their locations, and oversee such matters as primary and secondary prevention, vaccination administration and control of epidemics. NHS Hospital Trusts. 290 organisations administer hospitals, treatment centres and specialist care in about 1,600 NHS hospitals (many trusts maintain between 2 and 8 different hospital sites). NHS Ambulance Services Trusts NHS Care Trusts NHS Mental Health Services Trusts
In addition, several Special Health Authorities provide services in England and in some cases to the devolved NHS administrations. These include The Information Centre for health and social care,NHS Blood and Transplant, NHS Direct, NHS Professionals, NHS Business Services Authority, National Patient Safety Agency, National Treatment Agency and the National Institute for Health and Clinical Excellence (NICE).
Telephone support services are provided by the health services:-
England - NHS Direct 0845 46 47 Scotland - NHS 24 0845 42 42 42 4 Wales - NHS Direct Wales / Galw Iechyd Cymru 0845 46 47 Northern Ireland - Health&CareNI currently (20 Jul 2006) refers to NHS DirectFunding
The commissioning system
The principal fundholders in the English NHS system are the NHS Primary Care Trusts (PCTs), who commission healthcare from hospitals, GPs and others and pay them on an agreed tariff or contract basis, on guidelines set out by the Department of Health.
Patient charges and prescriptions
Except for set charges applying to most adults for prescriptions, optician services and dentistry, the NHS is free for all patients "ordinarily resident" in the UK at the point of use irrespective of whether any National Insurance contributions have been paid;
Where NHS dentistry is available charges as at August 2006 are: £15.50 for an examination;
Staff
A feature of the NHS, distinguishing it from other public healthcare systems in Continental Europe, is that not only does it pay directly for health expenses, it also employs the doctors and nurses that provide them and in most cases owns and runs its hospitals and clinics. (UK General Practitioners, in contrast, are almost all self-employed, and contract their services back to the NHS, usually in group practices. Recently however, a number of salaried GP posts have been created, often in poorer areas where health care provision has been harder for locals to access)
As of March 2005, the English NHS has 1.3 million employees, and is variously the third or fifth largest employer in the world, after the Chinese army, Indian Railways and (as argued by Jon Hibbs, the NHS's head of news, in a press release from March 22, 2005) Wal-Mart and the United States Department of Defense.
Wales
For the structure of the NHS in Wales see separate article NHS Wales.
Scotland
For the structure of NHS services in Scotland, see separate article NHS Scotland
Northern Ireland
For the structure of NHS services in Northern Ireland, see separate article Health and Care NI.
Criticism
The NHS has had some criticism at times. The ongoing NHS IT upgrade has also been subject to recent scrutiny. Availability of NHS dentistry is poor, with by March 2006 two million people in the UK trying but failing to register with an NHS dentist and overall figures of 55% of adults and 36% of children not registered with an NHS dentist.
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