National Health Service

The National Health Service (NHS) is the publicly-funded healthcare system of the United Kingdom. The organisation provides the majority of healthcare in the UK, from general practitioners to Accident and Emergency Departments, long-term healthcare and dentistry.

History

Before 1948, patients were required to pay for their own healthcare. Systems of health insurance were relatively undeveloped, so many of the poor were simply unable to obtain treatment when they were ill. Many charities were established to operate local hospitals, such as the Royal Free Hospital, and some local authorities operated local hospitals for local ratepayers, but provision was patchy and quality of care varied greatly. The mentally ill were often locked away in asylums, and the destitute elderly could end up in the workhouse.

Related Topics:
Health insurance - Charities - Royal Free Hospital - Local authorities - Asylum - Workhouse

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A "Panel" system was set up in 1911 under the aegis of David Lloyd George (and primary care records in England are still stored in "Lloyd George envelopes" although nowadays most working records in primary care are at least partially computerised).

Related Topics:
1911 - David Lloyd George

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In the aftermath of the Second World War, with a new spirit of social provision, Clement Attlee's Labour government created the NHS on 5 July 1948, 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. The same services would henceforth be provided by the same doctors and the same hospitals, but:

Related Topics:
Second World War - Clement Attlee - Labour - 5 July - 1948 - Aneurin Bevan - Tredegar

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• services were provided entirely free of charge at the point of use;
• instead, services were financed from central taxation;
• everyone was eligible for care (even people temporarily resident or visiting the country).

The original structure of the NHS had three arms:

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• Hospital Services - 14 Regional Hospital Boards were created in England and Wales to administer the great majority of hospital services. Beneath these were 400 Hospital Management Committees which directly administered their own hospitals. Teaching hospitals had different arrangements and were organised under Boards of Governors.
• Primary Care - GPs 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 they 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 and 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 prior to establishment of the NHS.

This was known as the tripartite system, which would continue until 1974. In addition, private healthcare continued in parallel to the NHS.

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By the 1950s, spending on the NHS far exceeded what had been expected by Parliament and the Treasury. Spiralling costs led to the introduction of a 5-shilling charge for prescriptions, and a £1 charge for dental treatment, in 1952. With updated pricing, these remain the major exceptions to the NHS being free at the point of use. The 1950s also saw the more rational planning of hospital services, dealing in part with some of the gaps and duplications that existed across England and Wales. The period also saw the growth in the number of medical staff and a more even distribution of these staff together 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 compulsorily admitted and detained in a mental hospital.

Related Topics:
1950s - Treasury - Shilling - £ - Mental Health Act of 1959 - Mental illness

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The 1960s has 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 healthcare 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 put forward proposals for major changes in the structure and organisation of the NHS.

Related Topics:
1960s - Primary healthcare - Enoch Powell

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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 increasingly clear that the NHS would never have the resources necessary to provide unlimited access to the latest medical treatments, especially in the context of an ageing population.

Related Topics:
1974 - 1982 - 1970s - Efficiency - 1980s - Ageing population

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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 report recommended the appointment of general managers with whom individual responsibility and accountability lay at all levels of the NHS. The report also recommended that clinicians be better involved in management processes. Financial pressures continued to place significant 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 papers Working for Patients and Caring for People were produced. These papers 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.

Related Topics:
1987 - Prime Minister - Margaret Thatcher - 1989 - White paper

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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 directly but instead "purchased" care from their own or other authorities' hospitals. Certain GPs became "fund holders" and were able to purchase care for their patients directly. The "providers" became independent trusts, which encouraged competition but also increased differences.

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