National Health Service

11 Key excerpts on "National Health Service"

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  Interprofessional Social Work

  Effective Collaborative Approaches

  • Anne Quinney, Trish Hafford-Letchfield(Authors)
  • 2012(Publication Date)
  • Learning Matters

    (Publisher)

  In order to appreciate the diverse roles, responsibilities and value bases of the range of health professionals, we will consider in this chapter the organisation of the National Health Service (NHS), the service delivery structures, and set these in a historical framework. The NHS, as its name implies, is a national centralised organisation. In this sense the structures through which healthcare is delivered have differed in a fundamental way from the traditional structures that determine and support the delivery of social work and social care. However, as we shall see in this chapter, in the last decade incremental changes leading to the restructuring of health service have led to much closer alliances between health and social care towards tackling social problems in a more holistic way. Prior to this, social work was predominantly organised and delivered by local authority, voluntary and independent-sector agencies and organisations that did not share a central overarching common identity with health. While all of these agencies have always had to adhere to the body of legislation and policy guidance that impact on the social work role, following a number of public inquiries and serious case reviews in different areas of social work there has been a subsequent radical reshaping of organisations, commissioning and contracting practice in the NHS. Services have become much more integrated with health, driven by legislation and policy guidance which asserts a more concerted move towards community-based provision. This chapter will provide a background history to developments in health in order to illustrate the significance of these changes in relation to collaborative practice both at an institutional, service and professional practice context starting with the original conception of the UK health service in 1948 up until the passing of the Health and Social Care Act 2012 which paints a very different picture indeed.

  A brief history

  The creation of the NHS 1948

  In 1944 the Ministry of Health explained that the aim of the National Health Service (NHS) was  

  to ensure that everybody in the country – irrespective of means, age, sex and occupation – shall have equal opportunity to benefit from the best and most up-to-date medical and allied services available. To provide, therefore for all who want it, a comprehensive service covering every branch of medicine and allied activity.

  (Ministry of Health 1944 p 47)

  Although introduced by a Labour government, there was cross-party support for the NHS. At the time of its conception, William Beveridge (chair of the Inter-Departmental Committee on Social Insurance and Allied Services that produced the report, known as the Beveridge Report) believed that the NHS would address all health needs and create a healthy population leading to a reduction in the demand for health services. This optimism was partially thwarted when during the year following the introduction of the NHS in 1948, set up to be free and universal, prescription charges were introduced and shortly afterwards charges were introduced for dentistry and optician services, so great had been the unforeseen demand for false teeth and spectacles. You will need to refer back to Chapter 1

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  Vital Notes for Nurses: Accountability

  • Helen Caulfield(Author)
  • 2011(Publication Date)
  • Wiley-Blackwell

    (Publisher)

  6 Structures: The Health Service 81 Learning objectives This chapter sets out the main components of a health service and the quality functions of the key agencies in England. This will enable nurses to place the NHS in context with the independent and private sectors in relation to rights and resources in accessing treatment and care. The learning objectives for this chapter are to: • fully describe the key components of any health service • understand where the UK provides rights to access treatment and care • assess the different sources of funding available for treatment and care • review the quality standards in a health service • place this in the context of agencies in England that assess quality of treatment and care. Introduction The National Health Service (NHS) is funded by taxpayers to provide a comprehensive service of health to all citizens of the UK. The independent sector is funded privately and provides services that may match or complement those provided in the NHS. Further health services may be provided by organisations that are voluntary or commercial, non-profit making or profit making. The policy of universal coverage of health care from the NHS provides: • primary care • secondary care • continuing care • social care • public health. The Health Service and devolution in the UK The health service is now devolved among the four countries of the United Kingdom. Since 1997 devolution across the UK has meant that England, Wales, Scotland and Northern Ireland can make health policy for their own country. This health policy is limited in different ways in each country, but overall the intention is to provide each country with responsibility for deciding its own health policy and how this is to be provided. Each Government will decide its priorities in health and then use the civil service to implement that health policy. Policy making for the structures of the NHS is carried out by a central government depart-ment in each UK country.

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  Healthcare in Private and Public from the Early Modern Period to 2000

  • Paul Weindling(Author)
  • 2014(Publication Date)
  • Routledge

    (Publisher)

  7    Healthcare as nation-building in the twentieth century The case of the British National Health Service Glen O’Hara and George Campbell GoslingGeorge Campbell Gosling Introduction

  On the ‘appointed day’ of Monday 5 July 1948, Britain’s Labour government introduced a whole raft of social reforms, including the inception of the National Health Service (NHS). In many respects the NHS is unique: ‘alone among its capitalist partners, the United Kingdom offered comprehensive health care to its entire population’.1 Labour created it by nationalising the nation’s municipal and voluntary hospitals, as well as instituting government funding of general practitioners, dentists and other healthcare providers on a per capita basis and mandating that local government provide certain public health services.2 This tripartite system was funded primarily from general taxation and made universally available free at the point of use. As such, the NHS has always entailed compromises between public and private: while GPs and dentists remain essentially private, the state funds NHS patients, who are thus seen without charge. For most of its history the NHS has been a free service, yet one with prescription charges. More recently it has also been a public service that has seen medical care increasingly provided either by private contractors to NHS patients, or by the NHS to private or ‘self-funded’ patients.3

  There is a common tendency towards national exceptionalism in all writing about the NHS, yet we can better understand the NHS by locating it within a wider tendency to use those reforms as part of nation-building and post-war rebuilding. In this way social reform has often been associated with attempts to rejuvenate ‘national spirit’ in the period after a crisis, such as war or depression.4

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  The New Managerialism and Public Service Professions

  Change in Health, Social Services and Housing

  • I. Kirkpatrick, S. Ackroyd, R. Walker(Authors)
  • 2004(Publication Date)
  • Palgrave Macmillan

    (Publisher)

  4 The National Health Service In the fifth decade [of the history of the NHS] the health service was redefined in terms of what would be provided and how the provision was to be organised…. Managed care was introduced. But the basic problem of rationing care persisted. Cash limits on purchasing authorities and the continual pres- sure of efficiency savings limited the work that providers could do. By 1997, although special programmes had reduced the numbers of patients who waited more then a year for admis- sion, waiting lists in general were lengthening, services were being cut and operations were being postponed nationwide. Consultants warned that during the winter months the NHS might be reduced to treating emergencies only, if under- funding were not remedied. The NHS was facing its worst financial crisis for a decade and was heading for financial melt- down. The reforms had not solved the basic NHS dilemma…. (Rivett, 1997: 453–4). The focus of this chapter is on the development of new management systems and practices and their effects on the professions within the National Health Service (NHS). In some ways this is a daunting task. The NHS has been cited as the largest employer in Europe, and, with total employees well over one million in recent decades, this is entirely plausible. 1 Furthermore, the health service is far from unitary, for much of its history being split into a number of different areas of activity and semi-autonomous services. General practitioner services have always been provided separately from hospital care, and the local authorities for a long time were responsible for some personal health services within the system. Within hospitals themselves, there have 76 been traditional differences between the district hospitals, specialist hospitals and teaching hospitals. In addition, each individual institu- tion within the system has enjoyed considerable clinical and operating autonomy, and has often developed a distinctive culture.

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  National Health Services of Western Europe

  Challenges, Reforms and Future Perspectives

  • Guido Giarelli, Mike Saks, Guido Giarelli, Mike Saks(Authors)
  • 2023(Publication Date)
  • Routledge

    (Publisher)

  a compromise in which the government subsidy was paid on a feefor-service basis, and GPs could charge co-payments over and above the government subsidy. The result was fully funded public hospitals operating alongside privately owned GPs with partial public funding.

  Notwithstanding such partial implementation in New Zealand, the three fundamental pillars on which a National Health Service (NHS) in a country with a free-market economy is based were planted: universal coverage regardless of income, funding from tax revenue and a comprehensive range of public health services provided free of charge at the point of delivery to all. And these pillars on which this book is based in a Western European context are the same as those we find in the establishment of the NHS in the UK in 1948. This was part of the new welfare state (Titmuss, 1958 ) centred on social citizenship entitlements that the Labour Government introduced for the first time in the West in a social security system based on the collectivisation of the risks of individual life (Marshall, 1950 ).

  The apparent paradox of a state-run healthcare system in the home country of liberalism and a liberal state, where a minimal state-supported health system of workhouse hospitals for the poor and a national insurance system for workers previously existed, can be seen in pragmatic terms as related to the favourable context for radical change. The first aspect of this was the epidemiological pressure of World War II, with large-scale civilian casualties and returning wounded or disabled soldiers, and the new therapeutic potential offered by the incipient pharmacological revolution with the discovery of antibiotics and sulphonamides which were unaffordable for most people. Although there are deeper theoretical debates about the reasons for the gestation of the NHS (see Saks, 2015b ), it was felt that a flat-rate universal contribution could be exchanged for a flat-rate universal benefit run by the state, as suggested in the Beveridge Report (Abel-Smith, 1992 ) – even though, as Blank and Burau (2007 :44) note, ‘the NHS did not resolve the tension between laissez-faire liberalism and collectivism and instead a generous entitlement philosophy has coexisted with rationed service provision’. In fact, since its inception and at least until the 1990s, the NHS suffered from chronic under-funding because ‘there was a lack of political will to commit the resources necessary to meet Bevan’s remit for the service’ (Gabe, 1997 :6) despite the naïve assumption that it would lead to a reduction in healthcare costs as diseases were cleared up and demand was reduced (Berridge, Webster and Walt, 1993

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  Social Services

  Made Simple Books

  • Tony Byrne, Colin F. Padfield(Authors)
  • 2014(Publication Date)
  • Made Simple

    (Publisher)

  A number of critical reports drew attention to these deficiencies and provided force to those who had been long arguing the case for a National Health Service. The health service 83 The National Health Service: development of an idea The suggestion of a state medical service was put forward by indi-vidual thinkers in the nineteenth century, and received its first semi-official backing in the minority report of the Royal Commission on the Poor Laws (1905-09). This document, largely attributed to Beatrice and Sidney Webb, argued the desirability of a unified and comprehensive health service, though not necessarily a free one. The 1911 National Health Insurance arrangements provided an important step in this direction by providing the 'panel' (free) doctor service for insured workers. In 1919 the Ministry of Health was created, and its accompanying Consultative Council, under the Chairmanship of Lord Dawson, produced a report in 1920 dealing with the organisation of medical care in the re-construction period after the First World War. This report criticised existing arrangements as being too fragmented and badly distributed. It sought a more unified approach based on a series of health authorities and health centres, and pursuing a distribution according to the needs of the community and available to all citizens. Support for comprehensive health provision also came from the Royal Commission on National Health Insurance, 1924-26. This suggested not only extending National Insurance coverage but also ultimately separating health entirely from insurance and financing the service from general taxation. Opposition from insurance bodies coupled with depressed economic conditions prevented any action along these lines.

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  From Dreams to Disillusionment

  Economic and Social Planning in 1960s Britain

  • Glen O'Hara(Author)
  • 2006(Publication Date)
  • Palgrave Macmillan

    (Publisher)

  7 Health Care and the NHS The National Health Service: history, nature, expenditure In January 1962 the Health Secretary, Enoch Powell, announced details of the most ambitious project hitherto mounted by the National Health Service: hospital plans for ten to fifteen years ahead. In an extra- ordinary example of planning’s appeal across the political spectrum, the otherwise free-market Powell lauded ‘the opportunity to plan the hospital service on a scale not possible anywhere else, certainly on this side of the Iron Curtain’. 1 This was a remarkable about-face, for the 1950s had seen the NHS relatively starved of resources as a share of national income. In relation to other social services, the NHS lost out to the Conservatives’ initial housing drive and the rising costs of social security: by 1959 health spending was scarcely higher than it had been in 1951, as can be seen from Figure 7.1. Most of Britain’s welfare state in this period has justifiably been characterised as ‘austere’: in that case, health spending was even more austere than were government outlays in other sectors. 2 As the figure also shows, however, money flowed much more freely after 1959, and a decade of generally very large rises in NHS spending lay ahead. What was behind this reversal? To answer this question it is important to note that the problem facing governments after 1945 was not whether they should intervene in health services, but rather what shape they should take. For its part, the National Government’s 1933 Local Government Act had already allowed councils, if they wished, to band together in Joint Hospital Planning Councils. 3 Labour, at least in the run up to their election victory in 1945, envisaged a more radical outcome: a salaried General Practitioner service working in health centres, bringing them together with local authority employees such as nurses and health visitors. The 167 wartime coalition’s 1944 White Paper on health also suggested local government control.

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  Health and Health Care in Britain

  • Rob Baggott(Author)
  • 2004(Publication Date)
  • Red Globe Press

    (Publisher)

  Bevan’s vision, skill and strategy made possible the political settlement that allowed the NHS to emerge. Moreover, this generated an organisational structure which, though flawed, was to last almost thirty years. The Experience of the NHS: 1948–79 The NHS provided a comprehensive system of health care, available to all, which was not based on the ability to pay at the point of delivery. The fact that the service was national raised the possibility that a high standard of health care could become available to all. The bringing together of a range of services under the direct responsibility of the Ministry of Health created the potential for a more coherent, planned and integrated health care system. Finally, the funding mechanism for the new service – based on taxation (with a contri-bution from National Insurance funds) – meant that spending on the NHS would be under the watchful eye of the Treasury. This arrangement ensured that the NHS became one of the most cost-effective health care systems in the world. 88 Health and Health Care in Britain The NHS became a popular institution. For the generation that lived under the previous system, it represented a major achievement. It was similarly popular with the generation that grew up with the welfare state. However, despite its popularity, the NHS has faced a number of problems during its life-time and has not always tackled these successfully (Webster, 1988, 1996). By the late 1970s the situation became so serious that even the considerable achievements of the NHS appeared to be under threat. The NHS came to be widely perceived as in a constant state of crisis (Haywood and Alaszewski, 1980). This impression continued throughout the 1980s and into the 1990s (see Chapter 5). Some of the difficulties facing the NHS were evident from its earliest days, and arose from its original organisational structure and financial framework. Others were new, reflecting fresh challenges and rising expectations of the service.

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  A Social History of Medicine

  Health, Healing and Disease in England, 1750-1950

  • Joan Lane(Author)
  • 2012(Publication Date)
  • Routledge

    (Publisher)

  However, as the war progressed, a widespread view seemed to grow that health should be a public priority. The Beveridge Committee on Social Insurance and Allied Services sat from June 1941 and, when it reported a year later, it called for 188 THE N AT I ONAL HEALTH SERVICE A comprehensive National Health Service [that] wil l ensure that for every citizen there is available whatever medical treatment he requires in whatever form he requires it, domiciliary or institutional, general, specialist or consultant, and will ensure also the provision of dental, ophthalmic and surgical appliances, nursing and midwifery and rehabil-itation after accidents. However, remunerating medical practitioners was a major dificulty in establish-ing the NHS, for as well as income from private patients, capitation fees fom fiendly societies and the like, practitioners had always been able to buy and sell their practices and partnerships, with the goodwill attached, as well as equip-ment (and fequently premises) at valuation, just like any other business enter-prise. Goodwill represented vitally important capital to the practitioner who moved or retired and was an asset, worth £2-3000 by the mid-1930s, to be sold on death. Medical relationships with the government had undoubtedly soured in 1941 when the National Health Insurance (NHI) level for panel patients was raised fom an upper annual income of £250 to £420, thereby including many middle class patients fom whom general practitioners had formerly received fees. The Treasury, meanwhile, was entirely opposed to medical salaries in any new scheme. In 1 944 one GP wrote, 'We are fighting this bloodiest of all wars for feedom and this is not the time to put forward a scheme that wil l, in the short passage of time, take feedom away fom the doctor and feedom and privacy fom the patient'.

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  World Insurance Trends

  • Davis W. Gregg, Dan M. McGill(Authors)
  • 2016(Publication Date)
  • University of Pennsylvania Press Anniversary Collection

    (Publisher)

  British National Health Service : A British View by J. Leslie McCallum, M.D. * I am in the position of having altered considerably what I had to say to you when I originally accepted your very kind invitations to come and address you on the British National Health Service. Events have moved so rapidly in the last month that what I am going to give you is really stop press news coupled with any impressions on my way over when I was trying, away from the heat of the battle as it were, to sort out my ideas on the present situation. JOINING OF STATE AND MEDICAL PROFESSION The British National Health Service is now deeply rooted in both the public and the medical profession of Great Britain after nine years of experience. I liave been studying this subject for nearly twenty years and working in the National Health Service myself since it started. Thinking very deeply as to what is the actual position, I am forced to the conclusion that the British National Health Service was born in the bomb-shelters, in the trenches, the ships, and on the airfields of the 1939—45 w a r · Both the profession and the public showed during the recent dispute (I should say at an estimate the public by 90 per cent to 10 per cent and the medical profession 75 per cent to 25 per cent) that they were not prepared to consider any upsetting of National Health Service arrangements. In fact, some of my profession now consider that withdrawal from the Service, for example, would be unethical, as it would involve a medical risk, possibly, to some patients. This is particularly true of the field of consultants and specialists and others working in hospital. Quite apart from the fact that they have a different form of contract with the government, being on a contract of service with a salary, their attitude was defi-nitely that at no point were they prepared to allow any patient in a hospital to suffer any medical deterioration in his condition during or because of this dispute with the government.

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  Gender and Health Care in the UK

  Exploring the Stereotypes

  • Bernadette C. Hayes, Pauline M. Prior, Jo Campling(Authors)
  • 2017(Publication Date)
  • Red Globe Press

    (Publisher)

  Contrary to expectations, it was men, and not women, who formed the majority in this population during the 1920s and 1930s (see Chapter 4). 22 Health Care in the UK The NHS – the increasing role of medicine in the lives of women As the 1930s drew to a close, the health service system was at crisis point. Voluntary hospitals struggled to stay in existence as charity funds dwindled. Local authority hospitals and welfare homes faced increasing burdens of care as the number of people in poverty increased due to the economic depression. The NHI scheme failed to protect thousands of vulnerable people (mostly men with dependent families) who lost their jobs in the inter-war years (see Baggott, 1998: 90). Finally, public health pro-grammes failed to solve inequalities in health. As the Second World War approached, there was a growing conviction that only a radical shake-up of the health services system, with strong direction and adequate funding from central government, would reverse the downward trend in the health of the nation. The solution came in the introduction of the NHS in 1948, which introduced a new structure – a tripartite system separat-ing hospitals, GP services and local authority services (commu-nity and public health) – for the health services. For the first time ever, all hospitals came under one administrative umbrella – though the teaching hospitals retained a privileged position in relation to the others. Thus, theoretically, at least, it would now be possible to plan a hospital service within the context of an overall health strategy. However, the delivery of this service would come with a large price tag. From the beginning, the NHS cost much more than anticipated. This was due partly to the poor state of inherited services (particularly hospitals) and partly to the increase in demand for services and in numbers of staff.

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