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 ?
The decision meant 11,750 NHS patients would either need to pay for private treatment or find a new NHS dentist.
A NHS Greater Glasgow and Clyde spokesman said: "We have stringent processes and procedures to effectively manage the asbestos in compliance with the Control of Asbestos Regulations 2012.
To address these inequalities, the NHS Standard Contract 2015/16 now includes the WRES, which involves reporting on a set of metrics--closing the gap between the experiences of BAEM staff and white staff and helping to create NHS boards that are diverse and reflective of the communities they serve.
Waheed Saleem, Birmingham & Solihull Mental Health NHS Foundation Trust; Kath Kelly, George Elliot Hospital NHS Trust; Martin Owen, Deloitte; Stuart Annan, George Elliot Hospital NHS Trust; Gurminder Khaira, Deloitte.
Experts say the NHS may have to pay out tens of millions in compensation.
Yesterday Dr Rimington, one of two GPs at the Hawkshead surgery, said: "I'm so delighted to top the NHS England poll.
The NHS employees will be competing in a variety of sports, including football, netball, table tennis, badminton and rounders.
Figures suggest there were 3,000 more deaths than expected at Colchester Hospital University NHS Foundation Trust, Tameside Hospital NHS Foundation Trust, Blackpool Teaching Hospitals NHS Foundation Trust, Basildon and Thurrock University Hospitals NHS Foundation Trust and East Lancashire Hospitals NHS Trust.
Authors of the report alerted authorities to problems at the Mid Staffordshire NHS Foundation Trust - where deaths rates were high for a number of years.
The provider of learning software systems for government, Independent Healthcare and National Health Service (NHS) organisations said customer feedback indicates that NHS Trusts select AT-Learning because it offers such a comprehensive learning platform and because of its links to the NHS' Electronic Knowledge and Skills Framework (e-KSF).
The international delegation, including Alan Spinks, from New Zealand's Ministry of Health, and Canadian health minister Don McMorris, found out more about how NHS Institute programmes are helping staff in the NHS implement major improvements on the front line.
A flagship government scheme to boost NHS dentistry in Wales is failing to help patients register for care, it was claimed last night.