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 ?
It obtained figures under the Freedom of Information Act from the NHS Business Services Authority on prescribing rates among nurses.
Contract awarded for - nhs business services authority charges - direct award
Finance Director of the Year sponsored by Barclays Corporate - award presenter Chris Rigg, Barclays Corporate with winner Michael Brodie, NHS Business Services Authority
Birmingham's three primary care trusts together gave out 13,811 prescriptions, the Black Country had 15,910, South Staffordshire PCT 4,873 and Solihull PCT dispensed 2,696, according to the NHS Business Services Authority.
The proposals were due to be discussed at a meeting between bosses at the NHS Business Services Authority, which manages the PPD, but were dropped from the agenda when Department of Health officials decided to get involved.
Implementing agency : NHS Business Services Authority (the "Authority") which is represented in the Procurement by the Secretary of State for Health
The NHS Business Services Authority, which oversees NHS Supply Chain, said the deal broke down to five contracts with maximum values of PS240million, PS160million, PS240million, PS80million and PS60million, adding up to PS780million.
uk WINNER Kylie Morgan, Barclays Bank plc Runners Up: Charlotte Packer, NHS Business Services Authority & Melanie Davies, NHS Business Service Authority.
The proposals to outsource pounds 8bn worth of nationwide NHS services are being considered by management body the NHS Business Services Authority, which is due to meet on Tuesday to rubber-stamp the privatisation plans
The big winners on the night were Barclays Bank in Sunderland, and the NHS Business Services Authority in Newcastle, which were winners of the prestigious North East Contact Centres of the Year awards for centres with more and fewer than 250 seats.
Figures obtained from the NHS Business Services Authority show that the worst place for insomnia is the North West which spends pounds 8.
A large and influential judging panel included Chris McCourt, chief operating officer of the North East Chamber of Commerce, Michael Brodie, finance director NHS Business Services Authority and vice president of CIPFA NE region and Dinah Bennett OBE, director, International Centre for Entrepreneurship and Enterprise.