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 ?
By Permjeet Dhoot, equality and health inequalities unit, NHS England
Dr Mike Dixon says, "We've ended up making the NHS a consumer service where everyone goes along and gets the most out of.
Angela Wale, Celesio; Dr Diane Reeves, NHS Birmingham South CCG; Simon Wormald, Deloitte.
Just months ago 14 hospitals were put under review for poor standards following a probe by NHS England medical director Sir Bruce Keogh.
The Royal College of General Practitioners said GPs now get the lowest share of total NHS funding on record, at 8%.
Lead organiser Amanda Oates, HR Director at The Walton Centre, said: "The NHS North West Games has been a huge success over the past two years and this year's was another fantastic event.
NHS 111 will be a different service to NHS Direct, using fewer nurses with the aim of directing callers to the most appropriate local service.
Sir Peter Carr, chairman of NHS North East, said: "The NHS belongs to us all and under the NHS Constitution we all have a right to be involved in the planning of local healthcare services.
Bernard Crump, chief executive of the NHS Institute, said: "We should be really proud that other countries are looking to learn from the NHS Institute and our success in working with the service to help improve the NHS.
Andrew Kelly, National Head of HR Policy and ER for NHS Direct, said: "Taking care of our people is mission critical - we simply can't provide the highest level of patient care without them.
The revised code effectively closes the loopholes in rules established in 2001 that prevented the NHS from recruiting staff from Third World countries unless there was an agreement between them.
Taking a massive political gamble that voters will see real benefits in the quality of the NHS before the next election, Mr.