British Government and Politics (JN 302)

The National Health Service (NHS)

1. NHS structure and operations 2. History of the NHS 3. Coalition government and the NHS 4. Current issues

Lecture Outline

NHS structure and operations

Largest and oldest public healthcare system in the world.

http://www.nhs.uk/Pages/HomePage.aspx

NHS net expenditure was £105 billion in 2012/13.

In 2012 the NHS employed 146,075 doctors, 369,868 qualified nursing staff, 153,472 qualified scientific, therapeutic and technical staff and 37,314 managers.

http://www.nhsconfed.org/Pages/home.aspx

NHS structure and operations

NHS Constitution http://www.nhs.uk/choi

ceintheNHS/Rightsandpledges/NHSConstitution/Pages/Overview.aspx

Core principles: Meets the need of

everyone Free at point of delivery Based on clinical need,

not ability to pay.

NHS funded about 80% out of general taxation and 20% deriving from:

NHS element of National Insurance contributions;

Prescription and drugs charges; Other income such as asset sales and

fundraising.

NHS structure and operations

NHS controlled by the Department of Health. Funding is allocated to geographically-based Clinical Commissioning Groups (211 across England).

NHS Trusts and private sector companies are commissioned to provide NHS services.

In addition to providing health care services the NHS is involved in doctor training (about 8,000 places for student doctors each year).

NHS structure and operations

History of the NHS

National health Service (NHS) started in 1948 by Attlee’s post-war Labour government.

Provided high-quality medical treatment ‘free at the point of need’.

Mounting concern over inequality between richest and poorest.

Roots in the Beveridge Report (welfare state) and Lloyd George’s (1911) National Insurance (NI) scheme (meant to insure low paid against sickness and unemployment).

http://www.youtube.com/watch?v=-ywP8wjfOx4

Vision of Health Minister Aneurin Bevin (Nye Bevin) – “We now have the moral leadership of the world”.

But by 1951 charges were introduced for prescriptions, opticians, and dentists.

Led to high profile resignations including Bevin. For40 years structure and funding remained the same:

centrally funded through taxation, government filtering money through to hospitals, surgeries and ambulance services. Health professionals and service staff employed by government.

History of NHS

History of NHS

Neo-liberal, Thatcherite ‘reforms’ of NHS and creation of internal health market saw end of post-war consensus from the late 1980s.

Management structures set up with generalists appointed to sit alongside clinical staff.

Introduction of general managers to run District Health Authorities (DHAs) - funds directed to local hospitals and surgeries.

Community based health care with GPs , dentists, and other primary care providers given control of budgets - attempt to end ‘one size fits all’ approach to targeted approach.

Outsourcing of medical and health support employment to private agencies.

Department of Health and Social Security (DHSS) split into Department of Health and Department of Social Security.

Further reforms under John Major created NHS trusts.

History of NHS

National Health Service and Community Care Act (1990): NHS trusts were defined as service providers; Hospitals, mental health units, ambulance services and

others directly involved made up NHS trusts with own management boards (practitioners and general managers);

GPs offered opportunity to become fund holders – could opt out of district health authorities; and

GP fund-holders, DHAs and family health service authorities (FHSAs) became purchasers of NHS primary care.

History of NHS

Criticisms of NHS reforms: Not all GPs wanted to opt out – by the time

Labour came into power 1997 fewer than half had signed up;

Internal market criticised for being too concerned with management - more interested in flow charts;

Major criticism – post code lottery.

History of NHS

Waiting lists increased – horror stories in the press and broadcasting.

By May 1997 1.3 mln people waiting for treatment and operations.

Cancelled operations. Stories of elderly and vulnerable falling ill

and dying while waiting for treatment.

History of NHS

Labour introduced the Health Act 1999. Introduced: Primary care trusts (PCTs) – local administrative organisations

that purchased clinical services; Strategic health authorities (SHAs) replaced DHAs – more

arm’s length administrative bodies. Responsible for monitoring local health care, publishing three-yearly health plans, promoting healthier lifestyles.

Greater power for DH and Secretary of State to set nationwide targets and standards of care.

Alan Milburn’s 10-year NHS plan in 2000 criticised for over-emphasising competition in NHS and allowing patients choice of being treated in private hospitals and clinics.

History of NHS

National Institute for Clinical Excellence (NICE) also established in 1999.

Executive agency of the NHS. Guidance on prevention of illness to both

general public and NHS workers. Advises governments on whether new and

existing clinical treatments, medicines and procedures should be made (or remain) available on the NHS.

History of NHS

Coalition government and the NHS

Coalition government decided to ‘ring-fence’ NHS from cuts in government spending (along with foreign aid and education).

Andrew Lansley’s Health and Social Care Act: Abolished Labour’s PCTs and installed clinical commissioning

groups (CCGs) that were run more directly by GPs; and Gave greater powers for NHS Trusts to be more free from the

NHS (although accompanied by less financial security). Trusts can now raise up to 49% of their funds through treating private patients.

SHAs replaced by more local authorities to promote health improvement and overall health care provision.

New health regulatory body – Monitor.

Coalition government and the NHS

After much public criticism, including from the British Medical Association (BMA), and a re-assessment ‘pause’ in the passage of the bill, the Act was finally passed in 2012.

http://www.nhs.uk/NHSEngland/thenhs/about/Pages/nhsstructure.aspx

Opposition (and overview) of the bill: http://www.bbc.co.uk/news/uk-politics-17171039 http://www.telegraph.co.uk/health/9106880/Read-t

his-and-prepare-to-fight-for-your-NHS.html

Coalition government and the NHS

Inquiry into the Mid Staffordshire NHS Foundation Trust.

http://www.independent.co.uk/news/uk/home-news/jeremy-hunt-mid-staffordshire-nhs-trust-will-be-dissolved-9154787.html

A number of NHS Trusts in financial difficulties:

http://www.bbc.co.uk/news/health-28439323

Current Issues

Cameron’s pledge to have GP surgeries open seven days a week:

http://www.theguardian.com/society/2013/oct/18/gps-condemn-cameron-surgeries-plan

A&E overcrowding: http://www.theguardian.com/society/2013/m

ay/21/hospital-overcrowding-more-death-serious-illnesses-mps

Current Issues

Data sharing plans: http://www.theguardian.com/society/2014/fe

b/18/nhs-delays-sharing-medical-records-care-data

Current Issues

‘Devolution’ of NHS control to Manchester: http://www.bbc.co.uk/news/uk-england-manc

hester-31656313

Some say NHS still provides good levels of care:

http://www.theguardian.com/society/2013/dec/31/healthcare-leaders-end-criticism-nhs-letter

Current Issues