National Health Service

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National Health Service

(in Britain) the system of national medical services since 1948, financed mainly by taxation

National Health Service (NHS)

the system of health care provided for all citizens by the UK government.

In 1948, after more than a century of public health reform, and in the centenary year of the first Public Health Act, the National Health Service was established. It occupies a unique position in British society because:

  1. it has the largest client group for social welfare since it provides care for people at all stages of the LIFE COURSE; and
  2. more than any other welfare institution established as a result of the BEVERIDGE REPORT of 1942, the NHS embodies the welfare principle – care as a social service rather than a market commodity. It is the subject of political debate because of New Right theories about the state and the responsibilities of individuals, and it is the subject of academic discussions concerning the power of the medical profession and the nature of illness and health in the UK.

The NHS was set up to provide a fully comprehensive service of curative and preventative medicine for physical and mental illness. The service was to be free at the point of treatment in accordance with the patient's medically defined needs. The means-test principle of eligibility was abolished and the service was funded centrally from insurance and taxation. Its architects believed that the NHS would mop up the pool of ill health and that full employment would combine with the other agencies of the welfare state to lead to higher standards of health and a long-term fall in demand for health services. This has not happened. Rising costs, changes in health expectations, changes in the pattern of disease, demographic change and the persistence of class-related illness (see BLACK REPORT) have resulted in high levels of demand. The balance of supply favours the acute, hospital, interventionist sector at the expense of the community, disability and geriatric sector. Garner (1979) refers to this as the ‘no hope, no power’ paradigm. These ‘Cinderella’ patients have no power themselves and no powerful medical interests ranged on their behalf. Their conditions require care rather than cure. In a profession where success is associated with high-technology medicine, conditions which hold out little hope of scientific advance or breakthrough are unattractive to ambitious doctors.

The development of the medical profession in the UK is inseparable from the history of the NHS since it guaranteed the medical monopoly and secured a number of professional rights, i.e.:

  1. the right to contract out of the NHS for private medicine;
  2. independence from some aspects of the NHS management structure for teaching hospitals;
  3. the right of the individual practitioner to prescribe whatever treatment he or she considered appropriate (clinical autonomy);
  4. systems of payment and administration which confirmed the status differentials between hospital doctors and general practitioners, consultants and the rest of the medical profession.

In the 1990s, the NHS has undergone reform. An internal market has been created with the intention of increasing the efficiency of service delivery and enhancing patient choice. The main change has been the institutionalization of a split between purchaser (Health Authority) and provider (hospitals, general practitioner and other services) with providers competing for service contracts. Hospitals and general practitioners have been encouraged to become ‘trusts’ or ’fundholders, i.e. units which function independently of Health Authority control. Other changes have involved the provision of a ‘patient's charter’, attempts to introduce performance-related pay for clinical staff, and decisions to abolish regional (but not District) Health Authorities. Critics of these changes are essentially anxious that the resort to market criteria is undermining the founding principle of the NHS (provision of care on the basis of need) with one that looks instead to costs and purchasing power.

References in periodicals archive ?
Hundreds of British nurses danced their hearts out at the London 2012 Olympic opening ceremony, as part of a glittering tribute to the British National Health Service.
Like the freshly orphaned toddlers there, I was dependent on the goodwill of others, from the sister of the ward to the cleaners in the British National Health Service hierarchy for the simplest of human needs: from a sip of water to adjustment of the morphine drip.
The British National Health Service (NHS) was formed and The World Health Organization was established by the United Nations.
UK) examines the British National Health Service and considers some of the key contemporary debates surrounding it and how they have affected its evolution.
But in a sign that the new directive could still face problems, the British national health service has said it would not fund any care abroad that would not be provided in Britain.
The British National Health Service (NHS) has completed two pilot studies to have doctors carry out abortions in their offices.
The British National Health Service used to do exactly what the Physicians' Working Group wants to do: It paid hospitals a fixed price for operating expenses and controlled capital expenditures to limit expansion and the purchase of new technologies.
Professor Marcus Longley believes that it is a collection of absurdities I WANT to explore what exactly the British National Health Service is, in all its marvellous absurdity.
The quality-adjusted life-year data contributed to the successful effort to get MS disease-modifying drugs accepted by the British National Health Service.
The trial, funded by the British National Health Service and the largest of its type ever conducted, will investigate the specific impact of nicotine on the developing human fetus and subsequently in infancy.
Department of Health and Human Services, and the British National Health Service.
With the current level of investment in the British National Health Service it is astounding that there is such a shortage of good books on hospital buildings where best practice with regard to both design and models of care are explained through a series of well researched and illustrated case studies.

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