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 ?
To understand the scale of the threat we face, look no further than the "WannaCry" virus that, among other things, almost shut down the British National Health Service this past May.
Culturally specific, it evokes British National Health Service infographics or Charles Raymond's illustrations for The Joy of Sex (1972), each concerned in their way with relation and care.
The brother of President John F Kennedy was in the UK for a five-day tour and came to the Midlands as part of his study into aspects of medicine and his investigation into the British National Health Service. Pictured on September 13, 1971
For example, the British National Health Service represented one quarter of the UK's public sector 'carbon footprint'--a measure of greenhouse gases.
The British National Health Service found itself on the brink of crisis Sunday, as a clash between unions and government could result in the first ever full junior doctors walkout in the NHS' 67-year history, according to (http://www.telegraph.co.uk/news/nhs/12167190/BMA-draws-up-plans-for-string-of-crippling-NHS-strikes.html) the Telegraph.
A February whistleblower report on the British National Health Service recommended stronger protections for health care whistleblowers and zero tolerance for retaliation.
In 1978 Italy reformed its health system by largely copying what it took to be the British National Health Service. But, in doing so, the Italians forgot that they were not British!
One of England's major political parties is advocating that mental health services be finally included as part the British National Health Service. This would be a giant step for the NHS and a reassuring sign that mental health is beginning to get the attention it deserves in other developed countries.
They're part of the British National Health Service and have free medical prescriptions and free university tuition.
Data from the British National Health Service enabled researchers to follow the participants for subsequent years and to see whether or not they had a heart attack or died from it by 2009.
[2] Nonstandard abbreviations: DOH, Department of Health; NHS, British National Health Service; ECR, electronic care record.
The British National Health Service is overstretched and does not always have the tools to deal with chronic disease or indeed disease prevention.

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