What is the NHS?
The National Health Service is the UK's publicly funded healthcare system. Founded on the principle that good healthcare should be available equally to rich and poor alike, the NHS provides treatment 'free at the point of use' for all UK residents.
Although funded centrally from taxation, the devolved administrations of Scotland, Wales and Northern Ireland are responsible for managing their own NHS services.
The NHS in England, by far the largest of the four, is run by the Department of Health headed by the Health Secretary. There are also ten Strategic Health Authorities (SHAs) which are responsible for managing and developing NHS care within their local area.
NHS treatment is divided into two main sections: primary care and secondary care.
Primary care includes services provided by GPs, pharmacists, dentists, opticians, and the NHS Direct 24 hour telephone advice line. All of these services are currently managed by Primary Care Trusts (PCTs) which play a major role in commissioning secondary care and providing community care services. PCTs control 80% of the NHS budget.
Secondary care, or 'acute healthcare', refers to such things as emergency treatment, specialist medical care, or surgery. NHS Trusts come under the secondary care section. These include Acute Trusts which manage hospitals and employ a large proportion of the NHS workforce, both medical and non-medical; Ambulance Trusts which manage the 12 ambulance services in England; and Foundation Trusts which are NHS hospitals and other NHS services run by local staff and communities as not-for-profit public benefit corporations. In addition there are Mental Health Trusts and Care Trusts both of which provide health and social care services.
The National Institute for Health and Clinical Excellence (NICE) is also controlled by the NHS. NICE provides clinical guidelines, makes recommendations on new and existing treatments, and sets quality standards for healthcare.
Background
Prior to the launch of the NHS in 1948, healthcare in Britain was of a very poor standard. Working men on low wages were able to see a 'panel doctor' in return for a compulsory four pence per week National Insurance contribution. However, women and children had to pay in order to obtain medical care and many could not afford to do so.
Infant mortality rates were high; almost four out of every 100 babies were either stillborn or died within the first week of birth and three in every 100 babies died before they were one year old. Diphtheria was common among children affecting 50,000 a year.
There were no antibiotics and infectious diseases such as tuberculosis, polio, pneumonia, meningitis and rheumatic fever killed thousands of people each year.
Hospitals also charged fees for treatment, although some care was subsidised by the voluntary and charity sectors while some consultants, who depended on private patients for their income, gave their services free of charge to the poor.
The idea for a National Health Service was mooted in the 1942 Beveridge report on 'Social Insurance and Allied Services.' Sir William Beveridge, the distinguished economist and social reformer, proposed that all working people should pay a weekly contribution to the State. This would be used to provide social insurance for everyone in Britain 'from cradle to grave' and would cover such things as unemployment, retirement – and healthcare.
When Labour returned to power in 1945, in the aftermath of the Second World War, Prime Minister Clement Attlee appointed Aneurin Bevan as health minister and it was he who, in 1946, steered legislation through the Commons for the National Health Service. Two years later on 5th July, 1948, the NHS officially came into being. Nye Bevan chose Park Hospital in Trafford, Manchester to launch the new service, where he was photographed shaking hands with the first ever NHS patient, 13 year old Sylvia Beckingham.
This revolutionary healthcare provision, said to be the envy of the world, was based on three core principles:
That it meet the needs of everyone
That it be free at the point of delivery
That it be based on clinical need, not ability to pay
Fourteen Regional Hospital Boards (RHBs) were established to administer services which were divided into three sections: hospitals; family doctors, dentists, opticians and pharmacists; and local community health services.
The RHBs were replaced in 1974 with Regional Health Authorities and in the same year the Ambulance Service became part of the NHS, having previously been controlled by local authority health departments. New principles were also added to the three core principles in July 2000 as part of a modernisation programme.
In the six decades since the NHS was launched, the services and treatments provided have expanded hugely. From penicillin to beta blockers, increasingly sophisticated drug treatments have been developed; hip and knee replacements and cataract operations are now commonplace and mental healthcare has improved markedly, as has treatment for cancer.
IVF, organ transplants, gene therapy all come under the NHS umbrella and research continues into finding ever better cures and treatments – reflecting the oft-quoted comment of Nye Bevan back in 1948: "This service must always be changing, growing and improving; it must always appear to be inadequate."
Controversies
The decision by Chancellor Hugh Gaitskell in April 1951 to introduce a one shilling prescription charge and to charge for half the cost of dentures and spectacles caused huge controversy and created a lingering left/right split within the Labour party itself.
Nye Bevan, Harold Wilson and John Freeman all resigned from the Cabinet in protest. But despite fears that more fees would be introduced, the NHS today is still free at the point of use with the exception of charges for some prescriptions and optical and dental services.
From the outset a constant stream of proposed and implemented reforms to the NHS by successive Tory and Labour governments has provoked criticism and confusion – something which continues today.
The last Labour government had 13 years in which to introduce endless new schemes, some more successful than others: de-centralisation, modernisation, targets to reduce waiting lists and increase capacity, GPs' contracts, 'patient choice', Primary Care Trusts, Foundation Hospitals, etc. And there was no shortage of funding for their plans; according to the King's Fund, NHS funding more than doubled during Labour's tenure.
The present Coalition government, following its election in May 2010, also pledged to protect NHS funding. Despite the need to reduce the UK's huge deficit, the Department of Health would be spared the swingeing cuts imposed on all other government departments in the October 2010 spending review: In fact, NHS spending would be increased in real terms in each year of the Parliament.
But as Health Secretary Andrew Lansley pointed out, no cuts to funding did not mean there would also be no further reform of the NHS and the Government duly outlined its wide-ranging modernisation plans in the Health and Social Care bill currently going through Parliament.
However, the proposed reforms provoked huge controversy and in April 2011, the Prime Minister, together with the Deputy Prime Minister and the Health Secretary launched a "listening exercise" on NHS modernisation. This would involve events running in every part of the country over the following two months to "give people a chance to get involved".
Andrew Lansley described this as: "taking the opportunity of a natural break in the passage of the Bill to pause, listen, reflect and improve." However, the Prime Minister warned: "Where there are good suggestions to improve the legislation, those changes will be made. But let me be clear, it is only through modernisation that we can protect the NHS and ensure the country has a truly world-class health service."
Statistics
Hospital and Community Health Services (HCHS):
The number of written complaints about hospital and community health services has increased by 13.4 per cent from 89,139 in 2008-09 to 101,077 in 2009-10. This is the largest increase since data was first published annually (1997-98).
The previous largest increase was 10.6 per cent between 1999-00 and 2000-01. Complaints have seen decreases (by as much as 4.5 per cent in 2006/07 and 2007/08) as well as increases over the years, with an overall average annual increase of 1.1 per cent since 1997-98.
Family Health Services:
There has been an increase (4.4 per cent or 2,158) in the number of written complaints about general practice (including dental) health services from 48,597 in 2008-09 to 50,755 in 2009-10. This compares to last year's increase which was 10.6 per cent.
Source: NHS Information Centre – 2011
The Department of Health (DH) settlement includes:
.. real terms increases in overall NHS funding in each year to meet the Government's commitment on health spending, with total spending growing by 0.4 per cent over the Spending Review period;
.. an additional £1 billion a year for social care through the NHS, as part of an overall £2 billion a year of additional funding to support social care by 2014-15;
.. a new cancer drugs fund of up to £200 million a year;
.. expanding access to psychological therapies;
.. continued funding for priority hospital schemes, including St Helier, Royal Oldham and West Cumberland; and
.. capital spending remaining higher in real terms than it has been on average over the last three Spending Review periods.
Source: Treasury; Spending Review – October 2010
Quotes
"If the same energy and innovation that went into reducing waiting times and hospital infections could be put into prevention and chronic care, the NHS could become truly world class. This will not be easy and it is vital that politicians engage in an honest dialogue with the public about the changes needed."
Professor Chris Ham, The King's Fund chief executive – 2010
"At the heart of our reforms are some simple common sense ideas – less bureaucracy, more power to local communities and more responsibility to those who know most about their patients. These ideas stay true to the vision of the founders of the NHS."
Deputy Prime Minister Nick Clegg – April 2011
"Patients and healthcare workers alike do not want to resist all change. But how do we tell when a change oversteps the mark and becomes a threat to the NHS values that we want to preserve?
"We think the answer is to set out the principles that make the NHS what it is – the enduring values that we want to see upheld. Then we intend to keep an eagle eye on the Government to spot when those principles are in danger."
UNISON 'vision for the future of the NHS' – March 2011
"I believe passionately in the NHS. It is our most precious national asset. And it is precisely for this reason that we want to safeguard the NHS for future generations."
Prime Minister David Cameron – April 2011
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