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 figures were based on data obtained under the Freedom of Information Act from the NHS Business Services Authority Pensions Division.
The NHS Business Services Authority (NHSBSA) is responsible for checking claims for free prescriptions and treatment, and then 'recovering' the money from those people who have claimed they do not need to pay.
The NHS Business Services Authority has promised to overhaul the system, which rakes in around PS4million a year.
Figures from the NHS Business Services Authority are very revealing.
STAFF from the NHS Business Services Authority, Newcastle, gave up a day working behind a desk for a charity shop takeover challenge in West Denton.
Other winners were: Accounting Technician of the Year - Gemma Waugh, Avec Partnership New Accountant of the Year - Paul Batchelor, The Sage Group Accountant of the Year - Graham Thomson, Quantum Pharmaceutical Business Finance Team of the Year - Balfour Beatty Worksmart Tax Advisor of the Year - Paul Price, KPMG LLP Corporate Finance Deal of the Year - PwC Public Sector Finance Team of the Year - Cleveland Police Finance Director of the Year - Michael Brodie, NHS Business Services Authority Branch of the Year - PwC Accounting and Finance Employer of the Year - NHS Business Services Authority The Outstanding Achievement Award - Robert Forrester.
Paul, who previously worked at the NHS Business Services Authority, said he was excited about his new role.
It obtained figures under the Freedom of Information Act from the NHS Business Services Authority on prescribing rates among nurses.
The new figures, from the NHS Business Services Authority, reveal the shocking scale of daily violence in England's hospitals, GP surgeries, ambulances and mental health units.
He continued his actions despite being repeatedly reminded of his obligations by the NHS Pension Scheme, the NHS West Midlands Counter Fraud and Security Management Service, NHS Business Services Authority and his PCT.