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300), is used on signs and leaflets throughout the NHS.]] The National Health Service ('''NHS''') is the publicly funded healthcare system of the United Kingdom . The organisations provide the majority of healthcare in the UK, from General Practitioner s to Accident And Emergency Department s, Long-term Healthcare and Dentistry .''' A feature of the NHS compared to other public healthcare systems in Continental Europe is that not only does it pay directly for health expenses ( except prescriptions and dentistry it is free at the point of use) it also employs the doctors and nurses that provide them and in most cases owns and runs its hospitals and clinics. However, under the Private Finance Initiative , an increasing number of hospitals have been built (or rebuilt) by private sector consortia and have non-medical services (such as catering) provided under long-term contracts by them. HISTORY Before 1948, when the original three National Health Services were created, patients were generally required to pay for their health care. Free treatment was sometimes available from teaching hospitals and Charities hospitals, such as the Royal Free Hospital . Some Local Authorities operated local hospitals for local ratepayers (under a system originating with the Poor Law but provision was patchy and quality of care varied greatly). Systems of Health Insurance were relatively undeveloped, and usually consisted of private schemes such as Friendly Societies . As the poorest could not afford the weekly subscriptions of these organisations, David Lloyd George the Chancellor Of The Exchequer in the Liberal Government of Herbert Asquith introduced the National Insurance Act in 1911. A small amount was deducted from the weekly wage, to which was added contributions from the employer and the government. These notional sums purchased a stamp which was affixed to a 'card' in the wages office. When the employee left the job of work he was 'given his cards' which he then lodged with his new employer. In return for the record of contributions, the workman was entitled to three benefits. Firstly, he could draw unemployment pay in between jobs. Next, he could obtain a retirement pension. Lastly, he was entitled to medical care, though not necessarily to the drugs prescribed. To do this, he registered with a doctor. Each doctor who participated in the scheme thus had a 'panel' of those insured under the system, and was paid a capitation grant out of the fund calculated upon the number. (The name survives in the "Lloyd George envelopes" in which most primary care records in England are stored, although today some working records in primary care are at least partially computerised). This imperfect scheme only covered certain trades and occupations, and was known as 'Lloyd George's Ambulance Wagon' However, due to cuts during the economic troubles of the '30s, many of the poor were unable to obtain treatment. In the aftermath of the Second World War , with a new spirit of social provision, Clement Attlee 's Labour government created the NHS. The structure of the NHS in England and Wales was established by the National Health Service Act 1946 (1946 Act) and the new arrangements were launched on 5 July 1948. This was under health and housing minister Aneurin Bevan who based the NHS on a coal-miners co-operative that he had seen in operation in his home town of Tredegar . Services would henceforth be provided by the same doctors and the same hospitals, but:
The original structure of the NHS had three arms: #Hospital Services - 14 Regional Hospital Boards were created in England and Wales to administer the majority of hospital services. Beneath these were 400 Hospital Management Committees which administered hospitals. Teaching hospitals had different arrangements and were organised under Boards of Governors. #Primary Care - GP s were independent contractors (that is they were not salaried employees) and would be paid for each person on their list. Dentists, opticians and pharmacists also generally provided services as independent contractors. Executive Councils were formed and administered contracts and payments to the contractor professions as well as maintaining lists of local practitioners and dealing with patient complaints. #Community Services - Maternity and Child Welfare clinics, Health Visitors , Midwives , health education, Vaccination & Immunisation and Ambulance services together with environmental health services were the responsibility of local authorities. This was a continuation of the role local government had held under the Poor Law. This was known as the ''tripartite system'', which would continue until 1974 . In addition, private health care continued parallel to the NHS. By the 1950s , spending on the NHS far exceeded what had been expected by Parliament and the Treasury . Rising costs led to the introduction of a 5- Shilling charge for prescriptions and a £ 1 charge for dental treatment, in 1952. With higher prices, these remain the major exceptions to the NHS being free at the point of use. The 1950s also saw the planning of hospital services, dealing in part with some of the gaps and duplications that existed in England and Wales. The period also saw growth in the number of medical staff and a more even distribution of them with the development of hospital outpatient services. The Mental Health Act of 1959 also significantly altered legislation in respect of Mental Illness and reduced the grounds on which someone could be detained in a mental hospital. The 1960s have been characterised as a period of growth for the NHS. In primary care a more equitable distribution of GPs was emerging as was the concept of the Primary Health Care team. The period also saw a growth in health centres. More mental health patients were discharged back into the community and Enoch Powell , who was Minister of Health in the early 1960s, predicted that many of the large mental health institutions would close within ten years. Concern also continued to grow about the structure of the NHS and the difficulties of the tripartite system which separated hospital, community and primary care services. A number of papers were published and committees and commissions established in the late 1960s which proposed changes in the structure and organisation of the NHS. The NHS in England was reorganised in 1974 to bring together services provided by hospitals and services provided by local authorities under the umbrella of Regional Health Authorities, with a further restructuring in 1982 . The 1970s also saw the end of the economic optimism which had characterised the 1960s and increasing pressures coming to bear to reduce the amount of money spent on public services and to ensure increased Efficiency for the money spent. Through the 1970s and 1980s , it became clear that the NHS would never get the resources necessary to provide unlimited access to the latest medical treatments, especially in the context of an Ageing Population . The 1980s also saw the introduction of General Management to replace the previous system of consensus management. This was outlined in the Griffiths Report of 1983. This recommended the appointment of general managers with whom i responsibility lay in the NHS. The report also recommended that clinicians be better involved in management. 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. From this review and in 1989 , two White Paper s ''Working for Patients'' and ''Caring for People'' were produced. These outlined the introduction of what was termed the "internal market", which was to shape the structure and organisation of health services for most of the next decade. In 1990 , the National Health Service & Community Care Act 1990 (in England) introduced an "internal market" into the NHS, whereby Health Authorities ceased to run hospitals but "purchased" care from their or other authorities' hospitals. Certain GPs became "fund holders" and were able to purchase care for their patients. The "providers" became independent trusts, which encouraged competition but also increased differences. STRUCTURE Responsibility for the National Health Services in Scotland, Wales and Northern Ireland belongs to each country's Devolved administration; the NHS for England is controlled by the UK government. England The NHS in England is managed at the top by the Department Of Health , which takes political responsibility for the service. It controls 28 Strategic Health Authorities (SHAs), which oversee all NHS operations in an area. These are being reduced to 10 SHAs with the intention of reduicing costs, reducing central control and fostering greater responsibility for decisions closer to the delivery of services. The SHAs are responsible for strategic supervison of:
In addition, several Special Health Authorities provide a health service to England. These include NHS Blood and Transplants, the NHS Direct and the National Institute For Health And Clinical Excellence (NICE). More information can be found at NHS England website {Link without Title} Wales NHS Wales is operated and managed by the Health and Social Care Department of the Welsh Assembly Government . Strategic Health Authorities in Wales are known as Local Health Boards (LHBs). A Welsh Trust will typically administer all hospitals in a region, as well as all community care and mental health functions. Most people in Wales will have access to a District General Hospital which provides a range of services on an outpatient, inpatient and day case basis. Some of these hospitals also provide specialist services such as burns and plastics and cardiac surgery. Wales has one main teaching hospital, the University Hospital Of Wales , based in Cardiff. The NHS also provides community services which includes district nurses, health visitors, midwives and community based Speech Therapists , Physiotherapists and Occupational Therapists . There are 12 regional Trusts that cover groups of local authority areas, as well as one further Trust for the Welsh Ambulance Service and another, Velindre, for the operation of nationwide agencies and services:
Another important organisation in the structure is Health Commission Wales . This is an executive agency of the Welsh Assembly Government whose primary role is to centrally organise and fund all Tertiary Care and other highly specialist services. It also provides advise and guidance about specialist services to other parts of NHS Wales. Scotland The NHS in of NHS Scotland. Provision of healthcare is the responsibility of 14 geographically-based NHS Boards. There are no NHS Trusts in Scotland; instead, hospitals are owned by and GPs contracted in by the local NHS Board. Provision of community and mental health care is also the responsibility of each local Board. They are supported in this task by NHS National Services Scotland and several other special health boards, including NHS Health Scotland (Public health and health education), Health Protection Scotland , NHS Education For Scotland (training and e-library), NHS Quality Improvement Scotland , and the Scottish Ambulance Service . The State Hospital For Scotland And Northern Ireland at Carstairs, which provides high security services for mentally disordered offenders and others who pose a high risk to themselves or others, is the responsibility of the State Hospitals Board for Scotland . Local NHS Boards The 14 local health boards are:
See Subdivisions Of Scotland for details of relationships between health boards and council areas. Northern Ireland In Northern Ireland , the NHS is administered by the Department of Health, Social Services and Public Safety . The Department is organised under a Permanent Secretary into several groups and one agency. These are the Planning and Resources Group, Strategic Planning and Modernisation Group and Primary, Secondary and Community Care Group and the 5 Professional Groups. The Department’s Executive Agency is the Northern Ireland Health and Social Services Estates Agency (known as Health Estates). The five professional groups are
Northern Ireland also has its own dedicated Ambulance Service . Other In addition to this hierarchy there are various internal bodies which have authority over particular matters. For example, the National Institute For Health And Clinical Excellence (NICE) is an NHS body which produces guidelines and standards for healthcare. FUNDING The NHS remains a system of healthcare intended to be "free at the point of delivery" paid for by taxes. Nigel Lawson , former Chancellor Of The Exchequer once said that it was the national religion. Private medical care is available in the UK, but it largely used as a "top up" service to obtain speedy operations. The NHS's budget for 2005-06 is over £80 billion. Contrary to popular belief, the founding principles of the NHS called for its funding out of general Taxation , not through National Insurance . As of March 2005, the 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 US Department Of Defense . [http://politics.guardian.co.uk/publicservices/story/0,11032,1443862,00.html POLITICAL ISSUES IN ENGLAND The future of the NHS and its organisation are major issues in British Politics and the Secretary Of State For Health is in a senior position in the British Cabinet . Though the Secretary of State and Department Of Health (UK) deal with a much wider range of issues, the NHS dominates the department and many government policies, such as anti- Smoking and Obesity campaigns are implemented by the NHS. In recent times, UK politicians have been trying to reduce waiting times for surgery and medical procedures. Although they have sometimes failed to meet some of the targets many claim that the NHS is respected worldwide, {Link without Title} as a role model for the Welfare State . The NHS National Programme For IT (NPfIT)— a large project to increase the use of Information Technology in the NHS in England (the Welsh equivalent is called Informing Healthcare ) — has been criticised for substantial overspending, from £6 billion to a potential £30 billion However this arises from confusion over the hardware and software procurement costs (the £6 billion) and the total costs of changing practices to use the new methods that the IT investment is intended to support (the £30 billion). There has also been criticism of a lack of patient information security [http://news.zdnet.co.uk/0,39020330,39173812,00.htm . The ability to deliver integrated high quality services will require care professionals to use sensitive medical data. This must be controlled and in the NPfIT model it is, sometimes too tightly to allow the best care to be delivered. One concern is that GPs and hospital doctors have given the project a lukewarm reception, citing a lack of consultation and complexity. [http://www.computerweekly.com/Article136585.htm] In 2005, Independent Sector Treatment Centre s (ISTCs) will treat around 3% of NHS patients (in England) having routine surgery. By 2008 this is expected to be around 10%. {Link without Title} OVERSEAS DOCTORS AND THE NHS: Staff shortages in the NHS during 50s and 60s led to recruitment of doctors from overseas, particularly the Indian subcontinent. This continues and Overseas Doctors contribute significantly to the NHS, especially in areas and posts which appear less glamorous or desirable to local doctors. In recent years, several overseas doctors won race discrimination claims against the NHS, highlighting the absence of career progression and other difficulties faced by doctors from overseas. SEE ALSO
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