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The National Health Service Structure and History
Transcript of The National Health Service Structure and History
The foremost problem with the NHS, is that it is run by politicians. The government is representative of the people ... on the whole the people know very little about NHS structure and spending - therefore the Minister leading the department is not expected to know anything about the NHS either.
So why is the NHS the way it is?
The NHS still works off the system that was created in the Beveridge Report - the NHS may have changed - but it still attempts to meet Beveridges founding principles.
The NHS is also a "victim of its own success" it provides such comprehensive and effective cover that it cannot cope with the demand for healthcare ... alongside the broad range of problems that it now deals with that were not around when it was created in 1948
However, history has created modern day problems. The BMA voted overwhelmingly against the creation of an NHS in the 1940's. They were happier working privatly as they made more money - This meant health provision was patchy as few doctors worked in deprived areas as there was no money there.
No new Hospitals were built until after 1951 - meaning healthcare did not improve - it just bacame free. This "Postcode lottery" of healthcare still exists today.
NHS Founding Principles
1. Collectivism - The responsibility of the state to provide healthcare for all.
2.Universal - The state would provide for the whole population Regardless of wealth. Revenue for the NHS comes from tax
3.Comprehensive - The NHS is responsible for all aspects of the population’s health care. People have the right to obtain health care outside the NHS, if they wish
4.Equality - The NHS wish to eradicate any inequalities within the NHS as it is for all, irrespective of their wealth
Therefore Aneurin Bevan - Minister for Health 1945 - 1951 bribed Doctors, by allowing them to continue having a private practice, and by allowing them to use NHS services for private patients
This practice still continues today!
The NHS also follows political objectives, as it is controlled by the Government - for example - Blair looked to cut waiting lists for the NHS in England, so a massive amount of capital was spent in operating more quickly - however the NHS was accused of dealing with less serious cases first as it drove down the waiting time, but the surgery etc was easy to perform - therefore allowing rapid treatment. Remember, that the NHS must meet the targets set by the controlling body - it is not independent.
Nor, in the true sense of the word is the NHS national, due to the conflicting structure of the NHS in Wales, Scotland, England and Northern Ireland.
England is the only nation in the UK to still have prescription charges
Scotland has a totally different structure of NHS Service than any other nation in the UK
Foundation hospitals are found only in England
The Minister for Health at Westminster has no control over the NHS in Scotland.
Bevan paid £66 Million to buy GP's practices and Doctors were ensured an extra £300 for working in deprived areas.
The cost of the NHS was surprising. The NHS budget rose from £134 Million in 1948, to £228 Million in 1949 and again to £356 Million in 1950. Today the NHS budget stands at £106 Billion (England).
After the NHS created prescriptions rose from 7 million per month to 13.5 Million per month. In the first year of the NHS 5.25 Million spectacles were dispensed and a further 1.3 Million were on order, and 8.5 Million dental patients were treated
The cost of the NHS led to the Labour government introducing Prescription charges - this led to the resignation of Anuerin Bevan - Minister for Health - as he said that it was against the NHS founding principles
Sources of finance for the NHS Budget
1. 88% taxation
2. 9% National Insurance
3. 3% charges
In Scotland the NHS budget rose from 70 Billion to 90 Billion. This is in line with EU health spending - a GDP increase from 8% to 9%
NHS Funding in the past and today
National Insurance was intended to fully fund the NHS - by 1951 it only funded 9% of its budget!
Formulation of NHS Policy
The Labour government of 1997 used the influential Black Report of 1980, that was replicated in the 1998 Acheson Report
The Black report was dismissed by the Tory government when it was produced as it undermined their work
However, the Labour gov't followed the reports conclusions. The basis of all NHS policy from 1997 to 2010 came from the Black Report, Acheson Report and Marmont Review
The question that nearly every Civil Servant asks themselves is "to what extent is the NHS meeting its founding principles - and how can we improve the service"
The Civil Service is the permenant administrative body of government. They are independent of gov't control and not political!
They implement policy and run departments day to day. They are the body that keep the country running.
Often they are not qualified for the post e.g. The Permenent Secretary to the Minister for Health does not have a degree in medecine, but will have worked in the DfH for his entire career
The NHS's primary function is healthcare. However their targets are set by Whitehall and determined by Gov't
The NHS is a black hole for money - with Blair investing 300 billion and still seeing little improvement
Outside Clinical level, Doctor's have little control of policy, drug procurment and the general structure of the NHS
The NHS is not National
The NHS aims to eradicate all health inequalities - regardless of wealth, situation, georgraphy or cause - has it failed?
The NHS is one of the most important political institutions in Britain - any percieved threats can make any political party lose elections - It will probably never ever be totally privatised - However, outsorcing anf commissiong will be more common
There is a stereotype of the political parties and their care of the NHS.
The Tories are often seen as the party in which the NHS will be cut ... privatised or changed so drastically it no longer meets the founding priciples
This view is no longer really viable - they want sweeping reform - but they will never have the electoral opportunity to change it.
Every Leader of the Tories since Major have worked incredibly hard to shirk off this image, as it costs them elections
Labour, however, is seen as a safe pair of hands for the NHS
As they created the NHS and have always been 'Socialist' whereas the Tories have a legacy of being the 'Nasty Party' e.g. Privitisation, cuts/ austerity and unemployment
The NHS as we have established does not operate off the same structure in different parts of the UK. The biggest divide is between Scotland and England. These will be the two comparisons that are made in this presentation
NHS England seperates itself into two broad groupings 1. Primary Care Trusts and 2. Secondary Care Trusts
These trusts are monitored and administered by four tiers of managment. Created by the NHS Reforms in 2011. Whilst originally there were Strategic Health Authorities whom are answerable to the Department of Health and the House of Commons
Primary Care Trusts are the first point of contact for the majority of people - the services provided range from NHS walk in centres through to Screening facilities
The Secondary Care Trusts are otherwise known as Acute Services which work on referral or needs services e.g. Hospitals or special areas of health e.g. Mental Health - More information can be found on your hand out.
NHS Scotland works slightly differently
NHS Scotland still has Primary Care and Secondary Care
Secondary Care however revolves purely around Hospital Trusts. Primary Care still ranges from GP's to the CHP (Community Health Practice - Sexual Health through to Maternity Support)
In Scotland the Ambulance Service, NHS Education, NHS24 and certain Hopsitals are run bu Special Health Boards
In Scotland, there are no Strategic Health Boards that administer both Primary and Secondary Trusts
There is on "Unified Health Board" that oversees both Primary Care and Secondary Care.
There are however Special Health Boards in each area that administer certain services.
These Unified Health Boards and Special Health Boards are answerable to the Scottish Parliament and associated Select Committees
Dumfries + Galoway
Ayrshire and Arran
1. Greater Glasgow and Clyde
If there are any further questions or queries - feel free to contact me
There are two very influential reports revolving around Scottish Healthcare at the moment
Living and Dying Well, was published in 2008, and championed by the Scottish Health Minister, Nicola Sturgeon. It focuses on the improvment of Palliative Care (Symptom and psychological treatment in terminal conditions) and the ability to give choices to the Patient e.g. The choice of where to die. This report gave Healthcare proffessionals a new focus on discussing death and choices with patients.
Another major report is the Quality Strategy which aims to "put people at the heart of the NHS"
The Quality Strategy looks at reducing bed waiting lists, risk assessments for patients and staff, Hospital aquired infections and cleanliness, amongst many other areas.
The Strategy looks at the Patient Experience of the NHS. It is a recognition that a Nurses, or Doctors, perception of the patients experience is different to their actual experience.
Many UHB's have hired Nurse/Healthcare Consultants, whose remit focuses on specific aspects of this report.
They look to empower the patient to make a positive and visible change to the NHS
The strategy also looks at support networks outwith the Hospitals, and "self care", which involves the signposting of patients to the right services which can enable them to continue tto take responsibility for their own care.
This is done collaboratively throughout primary and secondary care. The government also are looking at the integration of health and social care alongside the third sector - charities and public health.
"Being treated in the right place, at the right time, by the right person, with the right skills"
In Grampian there are a number of Nurse Consultants, who look at, for example Dementia, Cancer and Patient Experience
Three lessons from history
1. The NHS ideal of universal access at the point of need was unique and has retained its popularity. Politicians are likely to remain ultimately responsible through government tax funding.
2. Delivery of the ideal continues to present problems. The structures put in place in 1948 were flawed, giving doctors too great an influence, a focus on sickness rather than positive health, and a lack of democratic input.
3. Such structural problems, or attempts to deal with them, are often presented as new initiatives, when they have a history. How ‘polyclinics’ or local democracy operated in the past could inform today’s policy discussions.
Professor Virginia Berridge directs the Centre for History in Public Health at the London School of Hygiene and Tropical Medicine.
Dentists work off the same foundation principles as any other members of the NHS. They have however been dogged by a drift to the private sector in a way that medical staff have not to the same extent
Dentitsts still work with PCT's but under new legislation they work with a Central Commissioning Board. This looks to harmonise standards across the country. This approach has been used before - particularly in the 1980's. The BDA is supportive of the move
Victim of it's own success
Universal entitlement and access.