National Health Service


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Related to National Health Service: National Health Service Corps

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 Minister stressed that the Government has the political commitment to leave the National Health Service "under controlled indebtedness and a strategy of adequate budgetary utilization" until the end of the legislature.
He came from a humble mining background, and established the National Health Service, of which we should be very proud.
We have not had a Royal Commission on the NHS since the 1970s and this may be the way to go if the National Health Service is to survive.
Once again, from secretaries to nurses, doctors and administrators etc my experience with the National Health Service was brilliant.
The National Health Service is one of the world's greatest institutions and must not be allowed to wither.
The East Sussex Healthcare National Health Service Trust, in Hastings, recently signed 40 Filipino nurses to start in spring at Eastbourne District General Hospital, Conquest Hospital and in the community.
The National Health Service will always be a political issue while it is funded by taxpayers and valued by its patients.
org website says: "Aneurin Bevan, chief architect of the National Health Service, was one of the most important ministers of post-war Britain.
The only 'shareholders' who should benefit from the National Health Service should be the public who fund it.
This agreement is a significant milestone in our relationship with the National Health Service and represents a renewed commitment by the NHS and CSC to a long-term partnership as well as CSC's healthcare solutions," said Mike Lawrie, CSC's president and chief executive officer.
The National Health Service Corps (NHSC) Loan Repayment Program is accepting applications for 2011.
What is now needed is an open, public debate concerning how the people of Merseyside would like their National Health Service Royal Liverpool Hospital to be funded.

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